Provider Demographics
NPI:1952799009
Name:LEWIS, LESLIE ARLENE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:ARLENE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:LESLIE
Other - Middle Name:ARLENE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9850 ST LUKES DR STE 215
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-7912
Mailing Address - Country:US
Mailing Address - Phone:208-489-1983
Mailing Address - Fax:208-489-4300
Practice Address - Street 1:9850 ST LUKES DR STE 215
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-7912
Practice Address - Country:US
Practice Address - Phone:208-489-1983
Practice Address - Fax:208-489-4300
Is Sole Proprietor?:No
Enumeration Date:2014-12-23
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant