Healthcare Provider Details

I. General information

NPI: 1487017372
Provider Name (Legal Business Name): NICOLE LEW MSN APRN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 09/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 29TH ST SUITE 270
SACRAMENTO CA
95816-5125
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 916-455-3700
  • Fax:
Mailing address:
  • Phone: 800-470-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95004404
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: