Provider Demographics
NPI:1942551239
Name:LEWIS, LESLEY ROBYN (RN)
Entity Type:Individual
Prefix:MS
First Name:LESLEY
Middle Name:ROBYN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:ROBYN
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:6302 13TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:LUCERNE
Mailing Address - State:CA
Mailing Address - Zip Code:95458-1024
Mailing Address - Country:US
Mailing Address - Phone:707-274-9101
Mailing Address - Fax:707-274-9192
Practice Address - Street 1:6302 THIRTEENTH AVENUE
Practice Address - Street 2:
Practice Address - City:LUCERNE
Practice Address - State:CA
Practice Address - Zip Code:95458-1024
Practice Address - Country:US
Practice Address - Phone:707-274-9101
Practice Address - Fax:707-274-9192
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA429920163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse