Healthcare Provider Details

I. General information

NPI: 1003584640
Provider Name (Legal Business Name): WILLIAM NATHANIEL LEWIS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 WESTOWN PKWY STE 100
WEST DES MOINES IA
50266-1425
US

IV. Provider business mailing address

2425 WESTOWN PKWY STE 100
WEST DES MOINES IA
50266-1425
US

V. Phone/Fax

Practice location:
  • Phone: 515-267-1819
  • Fax: 515-401-1210
Mailing address:
  • Phone: 515-267-1819
  • Fax: 515-401-1210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number117882
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: