Provider Demographics
NPI:1619083870
Name:LEWIS, ELYN M (FNP)
Entity Type:Individual
Prefix:
First Name:ELYN
Middle Name:M
Last Name:LEWIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 SW BROOKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-7525
Mailing Address - Country:US
Mailing Address - Phone:503-640-4253
Mailing Address - Fax:
Practice Address - Street 1:12270 SW 1ST ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2848
Practice Address - Country:US
Practice Address - Phone:503-646-8222
Practice Address - Fax:503-626-7420
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR080045259N1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR247429Medicaid
OR247429Medicaid