Healthcare Provider Details

I. General information

NPI: 1316103435
Provider Name (Legal Business Name): KRISTINA SUZANNE LEWIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 02/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 SIERRA ROSE DR
RENO NV
89511-2060
US

IV. Provider business mailing address

661 SIERRA ROSE DR
RENO NV
89511-2060
US

V. Phone/Fax

Practice location:
  • Phone: 775-853-7669
  • Fax: 855-313-0186
Mailing address:
  • Phone: 775-853-7669
  • Fax: 855-313-0186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number184417
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN002520
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: