Provider Demographics
NPI:1568671402
Name:LEWIS, LESLY LYNNENE (LVN)
Entity Type:Individual
Prefix:MS
First Name:LESLY
Middle Name:LYNNENE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16144 QUANTICO RD E
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-1771
Mailing Address - Country:US
Mailing Address - Phone:760-240-0124
Mailing Address - Fax:
Practice Address - Street 1:16144 QUANTICO RD E
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1771
Practice Address - Country:US
Practice Address - Phone:760-240-0124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN212588164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse