Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 5066 | CA |
NPI | 1003999137 |
---|---|
Provider Name | Mrs. Lois Elaine Lewis |
First Address | Modesto, CA 95355 |
Second Address | Modesto, CA 95350 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 08/07/2007 |