Provider Demographics
NPI:1992327043
Name:LEWIS, PATRICIA MARIE (RN)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARIE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RN
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 20443
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85277-0443
Mailing Address - Country:US
Mailing Address - Phone:480-219-7986
Mailing Address - Fax:480-699-7693
Practice Address - Street 1:1848 N SOMERSET
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-3583
Practice Address - Country:US
Practice Address - Phone:480-219-7986
Practice Address - Fax:480-699-7693
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN106693163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management