Provider Demographics
NPI:1568454999
Name:LEWIS, CHRISTIIAN T (ARNP)
Entity Type:Individual
Prefix:
First Name:CHRISTIIAN
Middle Name:T
Last Name:LEWIS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 S COOLIDGE ST
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-1872
Mailing Address - Country:US
Mailing Address - Phone:509-793-9715
Mailing Address - Fax:509-764-3255
Practice Address - Street 1:1550 S PIONEER WAY
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-4613
Practice Address - Country:US
Practice Address - Phone:509-793-9785
Practice Address - Fax:509-764-3252
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005943363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9631953Medicaid
WA1013430Medicaid
WAAB36226Medicare ID - Type Unspecified