Provider Demographics
NPI:1225846769
Name:LEWIS, RANDILYN GRACE (RN, DNP)
Entity type:Individual
Prefix:
First Name:RANDILYN
Middle Name:GRACE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RN, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1593 BAKER RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-7503
Mailing Address - Country:US
Mailing Address - Phone:814-516-6498
Mailing Address - Fax:
Practice Address - Street 1:840 WOOD ST
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-1240
Practice Address - Country:US
Practice Address - Phone:814-393-1619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN620006163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse