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NPI Code Detail

MEDICARE: JAMIE LEWALLEN PA

MEDICARE: JAMIE LEWALLEN PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant1638CO

General Provider Information

NPI Number : 1346328408
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMIE LEWALLEN PA
Provider Business Mailing Address
First Line : 26659 PLEASANT PARK RD
Second Line :
City : CONIFER
State : CO
Zip : 80433-7714
Country : US
Telephone Number : 303-647-5300
Fax Number :
Provider Business Practice Location Address
First Line : 26659 PLEASANT PARK RD
Second Line :
City : CONIFER
State : CO
Zip : 80433-7714
Country : US
Telephone Number : 303-647-5300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2006
Last Update Date : 12/21/2020

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Directions to “ JAMIE LEWALLEN PA” Practice Location

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