Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 106025 | MO |
NPI | 1225150675 |
---|---|
Provider Name | Ms. Dina Rea Lewis |
First Address | Kansas City, MO 64180-1143 |
Second Address | Saint Louis, MO 63128-2106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2007 |
Last Update Date | 02/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1225150675 | (05) | MO |
149573 | HEALTH ALLIANCE (01) | MO |