Healthcare Provider Details

I. General information

NPI: 1063147155
Provider Name (Legal Business Name): JOANNA MARIE LEWIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 W ELM AVE STE 110
HERMISTON OR
97838-2713
US

IV. Provider business mailing address

2181 N OTT RD
HERMISTON OR
97838-7527
US

V. Phone/Fax

Practice location:
  • Phone: 541-567-2995
  • Fax: 541-567-7720
Mailing address:
  • Phone: 503-550-5513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number202210803NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: