Provider Demographics
NPI:1679650741
Name:LEWIS, GAYLE Y (WHCNP)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:Y
Last Name:LEWIS
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 GROVE STREET
Mailing Address - Street 2:P. O. BOX 1198
Mailing Address - City:JACKSONVILLE
Mailing Address - State:OREGON
Mailing Address - Zip Code:97530
Mailing Address - Country:UG
Mailing Address - Phone:541-899-7023
Mailing Address - Fax:
Practice Address - Street 1:622 GROVE STREET
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97530-1198
Practice Address - Country:US
Practice Address - Phone:541-899-7023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR080025187N7363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health