Provider Demographics
NPI:1356613269
Name:LEWIS-FAIRLEY, GIANA N (PA)
Entity type:Individual
Prefix:MS
First Name:GIANA
Middle Name:N
Last Name:LEWIS-FAIRLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1054 CASS AVE
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-4935
Mailing Address - Country:US
Mailing Address - Phone:401-767-3600
Mailing Address - Fax:401-767-3013
Practice Address - Street 1:1054 CASS AVE
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-4935
Practice Address - Country:US
Practice Address - Phone:401-389-2727
Practice Address - Fax:401-389-2727
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00615363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant