Healthcare Provider Details

I. General information

NPI: 1174834535
Provider Name (Legal Business Name): CHAD MICHAEL LEWIS N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 6TH ST
LEWISTON ID
83501-2431
US

IV. Provider business mailing address

415 6TH ST
LEWISTON ID
83501-2431
US

V. Phone/Fax

Practice location:
  • Phone: 208-799-6500
  • Fax: 208-799-5554
Mailing address:
  • Phone: 208-799-6500
  • Fax: 208-799-5554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP-959A
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP 60147797
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: