Provider Demographics
NPI:1518570415
Name:KELLEY-LEWIS, DAWN MICHELE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MICHELE
Last Name:KELLEY-LEWIS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2026 N IMPERIAL AVE STE C
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-1607
Mailing Address - Country:US
Mailing Address - Phone:760-592-4351
Mailing Address - Fax:
Practice Address - Street 1:2026 N IMPERIAL AVE STE C
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-1607
Practice Address - Country:US
Practice Address - Phone:760-592-4351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015303363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner