Provider Demographics
NPI:1578552261
Name:LEWIS, YVONNE W (PA-C)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:W
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3308 MELROSE RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-1604
Mailing Address - Country:US
Mailing Address - Phone:910-615-3200
Mailing Address - Fax:910-615-3201
Practice Address - Street 1:3308 MELROSE RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-1604
Practice Address - Country:US
Practice Address - Phone:910-615-3200
Practice Address - Fax:910-615-3201
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104170363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical