Provider Demographics
NPI:1134926033
Name:LEWIS, NINA LYNETTE (LP61420919)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:LYNETTE
Last Name:LEWIS
Suffix:
Gender:
Credentials:LP61420919
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1887 WHITNEY MESA DR # 8844
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2069
Mailing Address - Country:US
Mailing Address - Phone:509-481-4990
Mailing Address - Fax:
Practice Address - Street 1:10811 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:AIRWAY HEIGHTS
Practice Address - State:WA
Practice Address - Zip Code:99001-5345
Practice Address - Country:US
Practice Address - Phone:509-481-4990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA510616105208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice