Healthcare Provider Details

I. General information

NPI: 1528024007
Provider Name (Legal Business Name): VIRGINIA ANN LEWIS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N ORANGE ST SUITE 304
MISSOULA MT
59802-2998
US

IV. Provider business mailing address

PO BOX 12
LIBERTY LAKE WA
99019-0012
US

V. Phone/Fax

Practice location:
  • Phone: 406-329-5781
  • Fax: 406-327-3331
Mailing address:
  • Phone: 406-329-4142
  • Fax: 406-549-2246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number30731
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30003923
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: