Healthcare Provider Details

I. General information

NPI: 1619103793
Provider Name (Legal Business Name): CARESE LEWIS NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2009
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 W SAN CRISTOBAL RD
SAN TAN VLY AZ
85144-1103
US

IV. Provider business mailing address

4710 N 40TH ST
MILWAUKEE WI
53209-5812
US

V. Phone/Fax

Practice location:
  • Phone: 414-419-7652
  • Fax:
Mailing address:
  • Phone: 414-419-7652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number292468
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: