Healthcare Provider Details

I. General information

NPI: 1144714643
Provider Name (Legal Business Name): EMILIA LEWIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9801 FRONTIER AVE SE
SNOQUALMIE WA
98065-5200
US

IV. Provider business mailing address

9801 FRONTIER AVE SE
SNOQUALMIE WA
98065-5200
US

V. Phone/Fax

Practice location:
  • Phone: 425-831-2300
  • Fax:
Mailing address:
  • Phone: 425-831-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.PA.61231718
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12744
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: