Healthcare Provider Details

I. General information

NPI: 1396015871
Provider Name (Legal Business Name): TONYA R LEWIS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2011
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 VALLEY VIEW DR
MOLINE IL
61265-6138
US

IV. Provider business mailing address

545 VALLEY VIEW DR
MOLINE IL
61265-6138
US

V. Phone/Fax

Practice location:
  • Phone: 309-762-5560
  • Fax: 309-762-7351
Mailing address:
  • Phone: 309-762-5560
  • Fax: 309-762-7351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209008775
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN141196
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number752467
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: