Individual
LEWIS DALE FANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN, NP
Contact information
Practice address
50 SHRADER ST, SAN FRANCISCO, CA 94117-1015
(415) 668-4166
Mailing address
368 FELL ST, SAN FRANCISCO, CA 94102-5144
(415) 861-0828
(415) 861-0257
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
801999
CA
363LA2200X
Adult Health Nurse Practitioner
Primary
23521
CA
Other
Enumeration date
08/15/2013
Last updated
01/29/2019
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