1477659829 NPI number — ALYSE NICOLE LEWIS PA-C

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477659829 NPI number — ALYSE NICOLE LEWIS PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWIS
Provider First Name:
ALYSE
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARLAN
Provider Other First Name:
ALYSE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477659829
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6404 LAKESHORE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUINTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23141-1204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5801 BREMO RD
Provider Second Line Business Practice Location Address:
RICHMOND EMERGENCY PHYSICIANS INC
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23226-1907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-287-7066
Provider Business Practice Location Address Fax Number:
804-673-9531
Provider Enumeration Date:
09/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  0110002313 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0110002313 . This is a "VA STATE LICENSE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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