Provider Demographics
NPI:1114759032
Name:LEWIS, SIOHBAN NICOLE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:SIOHBAN
Middle Name:NICOLE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 COLONIAL SOUTH DR SW
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-4232
Mailing Address - Country:US
Mailing Address - Phone:404-374-3659
Mailing Address - Fax:
Practice Address - Street 1:1804 COLONIAL SOUTH DR SW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-4232
Practice Address - Country:US
Practice Address - Phone:404-374-3659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN254594363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily