Individual
PETRINA CELESTE LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
9343 E SHEA BLVD # B-130, SCOTTSDALE, AZ 85260-6802
(425) 277-3668
(425) 277-0732
Mailing address
4300 TALBOT RD S, SUITE 102, RENTON, WA 98055-6238
(425) 277-3668
(425) 277-0732
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
P000000595
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
156354
DEPT OF L&I
WA
05
—
7110729
—
WA
01
—
POD000986
PODIATRY LICENSE
AZ
Enumeration date
07/12/2005
Last updated
07/28/2021
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