Provider Demographics
NPI:1831185230
Name:LEDEE-LEWIS, KAREN ANN (NP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:LEDEE-LEWIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6107 N 1ST ST STE 103
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5460
Mailing Address - Country:US
Mailing Address - Phone:559-432-5697
Mailing Address - Fax:559-432-0228
Practice Address - Street 1:6107 N 1ST ST STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5460
Practice Address - Country:US
Practice Address - Phone:559-432-5697
Practice Address - Fax:559-432-0228
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11165NP207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P32167Medicare UPIN
ZZZ01252ZMedicare ID - Type Unspecified