Provider Demographics
NPI:1720096944
Name:LEWIS, STEPHANIE EVETTE (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:EVETTE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 N BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-2905
Mailing Address - Country:US
Mailing Address - Phone:909-709-1223
Mailing Address - Fax:909-709-1223
Practice Address - Street 1:1444 N BIRCH AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-2905
Practice Address - Country:US
Practice Address - Phone:909-709-1223
Practice Address - Fax:909-709-1223
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP11508363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHP11508OtherBOARD OF REG NURSING