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General NPI Number Information
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NPI Number | 1245098755
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Entity Type | Individual
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Provider Name | JESSICA ANNE LEWIS FNP-C
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Gender | Female
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Dates
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Enumeration Date | 03/08/2024
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Last Update Date | 12/27/2024
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Provider Practice Location Address
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Address Line | 415 6TH ST
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City | LEWISTON
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State | ID
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Zip | 83501
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Country | US
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Telephone | 208-750-7445
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Fax | 208-750-7395
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Provider Business Mailing Address
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Address Line | 415 6TH STREET ATTN: PHYSICIAN SERVICES
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City | LEWISTON
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State | ID
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Zip | 83501-2434
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Country | US
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Telephone | 208-750-7462
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Fax | 208-750-7467
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 35472
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 78877
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License Number State | ID
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