Healthcare Provider Details

I. General information

NPI: 1598144297
Provider Name (Legal Business Name): REBECCA LEWIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3270 CHURN CREEK RD
REDDING CA
96002-2504
US

IV. Provider business mailing address

1920 CALIFORNIA ST STE A
REDDING CA
96001-1953
US

V. Phone/Fax

Practice location:
  • Phone: 530-222-3287
  • Fax: 530-222-8547
Mailing address:
  • Phone: 530-247-7070
  • Fax: 530-244-7246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number687013
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: