Individual
KIMBERLY LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4212 N 16TH ST, PHOENIX, AZ 85016-5319
(602) 263-1200
(602) 263-1631
Mailing address
P O 0698, PASADENA, CA 91110-0001
(602) 263-1200
(602) 263-1631
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP 00050440
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
BENZ008
—
AZ
Enumeration date
01/08/2009
Last updated
01/08/2009
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