Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 569 | CA |
NPI | 1083279905 |
---|---|
Provider Name | Jadevyonna Lewis |
First Address | Apple Valley, CA 92307-2240 |
Second Address | Apple Valley, CA 92307-2152 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2019 |
Last Update Date | 11/06/2019 |