Provider Demographics
NPI:1740006949
Name:LEWIS, JENNA N (BSN, RN)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:N
Last Name:LEWIS
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 S 1425 W
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-8439
Mailing Address - Country:US
Mailing Address - Phone:801-651-0406
Mailing Address - Fax:
Practice Address - Street 1:1510 W 5400 S
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-5310
Practice Address - Country:US
Practice Address - Phone:385-646-7357
Practice Address - Fax:385-646-4256
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT288758-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse