Healthcare Provider Details

I. General information

NPI: 1235905381
Provider Name (Legal Business Name): ANGELA LEWISON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9909 JASMINE DR
MANHATTAN KS
66502-2065
US

IV. Provider business mailing address

9909 JASMINE DR
MANHATTAN KS
66502-2065
US

V. Phone/Fax

Practice location:
  • Phone: 785-410-0725
  • Fax:
Mailing address:
  • Phone: 785-410-0725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number13-139854-111
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: