Healthcare Provider Details

I. General information

NPI: 1316253990
Provider Name (Legal Business Name): ANDREA LEWIS APRN- FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2010
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11723 OLD GLENN HWY STE 213
EAGLE RIVER AK
99577-7750
US

IV. Provider business mailing address

PO BOX 672154
CHUGIAK AK
99567-2154
US

V. Phone/Fax

Practice location:
  • Phone: 907-854-6877
  • Fax: 888-892-4144
Mailing address:
  • Phone: 907-854-6877
  • Fax: 888-892-4177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26350
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number156904
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: