Healthcare Provider Details

I. General information

NPI: 1881994895
Provider Name (Legal Business Name): SUSAN LEWIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10120 S EASTERN AVE STE 203
HENDERSON NV
89052-3926
US

IV. Provider business mailing address

10120 S EASTERN AVE STE 203
HENDERSON NV
89052-3926
US

V. Phone/Fax

Practice location:
  • Phone: 702-994-8050
  • Fax: 702-441-8181
Mailing address:
  • Phone: 702-994-8050
  • Fax: 702-714-7409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberAPRN002232
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN002232
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN002232
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN002232
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: