Provider Demographics
NPI:1740034388
Name:LEWIS, DANA-MARIE (CNA)
Entity type:Individual
Prefix:
First Name:DANA-MARIE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 RANDALL ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-2035
Mailing Address - Country:US
Mailing Address - Phone:360-591-5234
Mailing Address - Fax:
Practice Address - Street 1:201 7TH ST
Practice Address - Street 2:
Practice Address - City:HOQUIAM
Practice Address - State:WA
Practice Address - Zip Code:98550-2506
Practice Address - Country:US
Practice Address - Phone:360-532-5454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANC10044751376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide