Provider Demographics
NPI:1841956679
Name:LEWIS, ANNIKA (FNP)
Entity type:Individual
Prefix:
First Name:ANNIKA
Middle Name:
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 1:1411 SECRET RAVINE PKWY STE 180
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-6043
Mailing Address - Country:US
Mailing Address - Phone:916-774-0484
Mailing Address - Fax:
Practice Address - Street 1:1411 SECRET RAVINE PKWY STE 180
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-6043
Practice Address - Country:US
Practice Address - Phone:916-774-0484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017766363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner