Provider Demographics
NPI:1538132196
Name:LEW, STEPHANIE A (CRNA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:LEW
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 E 20TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-9039
Mailing Address - Country:US
Mailing Address - Phone:505-326-6400
Mailing Address - Fax:505-326-4606
Practice Address - Street 1:801 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5630
Practice Address - Country:US
Practice Address - Phone:505-326-6400
Practice Address - Fax:505-326-4606
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJR16540367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ336710Medicaid
CO97459770Medicaid
NMH7375Medicaid
NM201005821OtherPRESBYTERIAN HP
UTT0966Medicaid
NM10002239OtherLOVELACE HP
NMNM006484OtherBCBS
NMNM006484OtherBCBS
NMP0036285Medicare PIN