Provider Demographics
NPI:1487159182
Name:COTTON-LEWIS, DITHRA ANN
Entity type:Individual
Prefix:
First Name:DITHRA
Middle Name:ANN
Last Name:COTTON-LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DITHRA
Other - Middle Name:ANN
Other - Last Name:COTTON-LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:6920 S CIMARRON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2135
Mailing Address - Country:US
Mailing Address - Phone:702-326-2340
Mailing Address - Fax:702-462-9328
Practice Address - Street 1:8225 W SAHARA AVE STE C
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-8929
Practice Address - Country:US
Practice Address - Phone:702-326-2340
Practice Address - Fax:702-462-9328
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002870363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily