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General NPI Number Information
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NPI Number | 1619436771
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Entity Type | Individual
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Provider Name | JOHN CORBRIDGE LEWIS APRN-RNP
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Gender | Male
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Dates
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Enumeration Date | 03/18/2019
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Last Update Date | 04/06/2023
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Provider Practice Location Address
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Address Line | 1876 E SABIN DR
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City | CASA GRANDE
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State | AZ
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Zip | 85122-6197
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Country | US
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Telephone | 520-836-9800
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Fax | 520-836-1510
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Provider Business Mailing Address
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Address Line | 2730 E WALNUT DR
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City | TAYLOR
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State | AZ
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Zip | 85939-2658
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Country | US
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Telephone |
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Fax |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 219712
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 219712
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License Number State | AZ
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