Provider Demographics
NPI:1568829109
Name:LEW, MANDI E (CNM)
Entity Type:Individual
Prefix:MRS
First Name:MANDI
Middle Name:E
Last Name:LEW
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-4202
Mailing Address - Country:US
Mailing Address - Phone:307-362-1861
Mailing Address - Fax:
Practice Address - Street 1:2620 COMMERCIAL WAY STE 140
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-4750
Practice Address - Country:US
Practice Address - Phone:435-755-6061
Practice Address - Fax:307-448-2250
Is Sole Proprietor?:No
Enumeration Date:2016-01-27
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY22001.1483367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife