Provider Demographics
NPI:1689130403
Name:LEWIS, JENNIFER ROSANN (CNA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROSANN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8650 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:WINNEMUCCA
Mailing Address - State:NV
Mailing Address - Zip Code:89445-6661
Mailing Address - Country:US
Mailing Address - Phone:775-403-3247
Mailing Address - Fax:
Practice Address - Street 1:118 E HASKELL ST
Practice Address - Street 2:
Practice Address - City:WINNEMUCCA
Practice Address - State:NV
Practice Address - Zip Code:89445-3247
Practice Address - Country:US
Practice Address - Phone:775-623-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-17
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV821055163WM0705X
NVCNA032875376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV821055OtherSTATE BOARD OF NURSING NEVADA REGISTERED NURSE
NVCNA032875OtherSTATE BOARD OF NURSING