Provider Demographics
NPI:1649879685
Name:LEWIS, DEVRA (LPN)
Entity type:Individual
Prefix:
First Name:DEVRA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 693
Mailing Address - Street 2:
Mailing Address - City:WHITE SWAN
Mailing Address - State:WA
Mailing Address - Zip Code:98952-0693
Mailing Address - Country:US
Mailing Address - Phone:509-874-2979
Mailing Address - Fax:509-874-2113
Practice Address - Street 1:80 BIRDSONG LANE
Practice Address - Street 2:401 FORT ROAD
Practice Address - City:WHITE SWAN
Practice Address - State:WA
Practice Address - Zip Code:98952
Practice Address - Country:US
Practice Address - Phone:509-874-2979
Practice Address - Fax:509-874-2113
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00050979164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALP00050979Medicaid