Provider Demographics
NPI:1316253990
Name:LEWIS, ANDREA (APRN- FNP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:APRN- FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 672154
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-2154
Mailing Address - Country:US
Mailing Address - Phone:619-395-2876
Mailing Address - Fax:
Practice Address - Street 1:21249 OLD GLENN HIGHWAY (MOBILE PRACTICE)
Practice Address - Street 2:
Practice Address - City:CHUGIAK
Practice Address - State:AK
Practice Address - Zip Code:99567
Practice Address - Country:US
Practice Address - Phone:907-854-6877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2024-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK156904363L00000X
AK26350163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNURR26350OtherSTATE OF ALASKA NURSING BOARD RN LICENSE
AK156904OtherSTATE OF ALASKA NURSING BOARD ANP LICENSE