Provider Demographics
NPI:1659158715
Name:LEWIS, PAMELA KATHRYN
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:KATHRYN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 E KATIE AVE APT 72
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5627
Mailing Address - Country:US
Mailing Address - Phone:702-559-1959
Mailing Address - Fax:
Practice Address - Street 1:625 N LAMB BLVD STE 130
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-6355
Practice Address - Country:US
Practice Address - Phone:702-331-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant