Individual
AMANDA L LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
103 CHICO CT, MONTE VISTA, CO 81144-1065
(719) 852-9400
Mailing address
310 COUNTY ROAD 14, DEL NORTE, CO 81132-8719
(719) 657-4102
(719) 657-4106
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4185
CO
363AM0700X
Medical Physician Assistant
2181
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
851148
—
AZ
Enumeration date
09/26/2006
Last updated
08/08/2016
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