Healthcare Provider Details

I. General information

NPI: 1689096208
Provider Name (Legal Business Name): STEPHANIE LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2014
Last Update Date: 01/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1572 SILVER SAGE LN
CORVALLIS MT
59828-9573
US

IV. Provider business mailing address

1572 SILVER SAGE LN
CORVALLIS MT
59828-9573
US

V. Phone/Fax

Practice location:
  • Phone: 406-360-8904
  • Fax:
Mailing address:
  • Phone: 406-360-8904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number337337
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: