Healthcare Provider Details

I. General information

NPI: 1982924601
Provider Name (Legal Business Name): NINA LEWIS N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6081 N 1ST ST STE 104
FRESNO CA
93710-5466
US

IV. Provider business mailing address

6081 N 1ST ST STE 104
FRESNO CA
93710-5466
US

V. Phone/Fax

Practice location:
  • Phone: 403-585-9023
  • Fax:
Mailing address:
  • Phone: 403-585-9023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND 454
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number10-1187
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: