Individual
DIANA LOUISE LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
NM STATE HIGHWAY 120,, MILE MARKER 12.5, OCATE, NM 87734
(505) 666-2475
Mailing address
NM HIGHWAY 120 @MILE MARKER 12.5, SOUTH SIDE OF HIGHWAY, P.O. BOX 203, OCATE, NM 87734
(505) 666-2475
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R24775
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
22002570
—
NM
05
—
41903765
—
NM
01
—
NM400019
INDIVIDUAL PTAN
NM
01
—
NMB2163
GROUP PTAN NMB2163
NM
Enumeration date
10/31/2005
Last updated
06/27/2011
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