Provider Demographics
NPI:1831664846
Name:LEWIS, LESLEE ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:LESLEE
Middle Name:ANN
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 1:120 E 2ND ST STE 400
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1577
Mailing Address - Country:US
Mailing Address - Phone:814-456-8980
Mailing Address - Fax:814-451-0443
Practice Address - Street 1:120 E 2ND ST STE 400
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1577
Practice Address - Country:US
Practice Address - Phone:814-456-8980
Practice Address - Fax:814-451-0443
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA060217363A00000X, 363AM0700X
PAOA006175363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical