Provider Demographics
NPI:1427485242
Name:LEWIS, NICOLE COLETTE (FNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:COLETTE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1123 KAIMALIE ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-5019
Mailing Address - Country:US
Mailing Address - Phone:808-218-4078
Mailing Address - Fax:
Practice Address - Street 1:91-1123 KAIMALIE ST
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-5019
Practice Address - Country:US
Practice Address - Phone:808-218-4078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1619363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily