Provider Demographics
NPI:1669072328
Name:LEWIS, IRMARITA (FNP)
Entity type:Individual
Prefix:
First Name:IRMARITA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1652 W TEXAS ST STE 115
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-5952
Mailing Address - Country:US
Mailing Address - Phone:707-470-2888
Mailing Address - Fax:866-626-0793
Practice Address - Street 1:1652 W TEXAS ST STE 115
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5952
Practice Address - Country:US
Practice Address - Phone:707-470-2888
Practice Address - Fax:866-626-0793
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA831617163W00000X
CA95016414363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse