Individual
IVY LEWIS LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4414 DEER AVE, CHUBBUCK, ID 83202-2668
(208) 317-3364
Mailing address
2293 JACQUELINE LN, POCATELLO, ID 83201-1867
(208) 317-3364
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
14873
ID
Other
Enumeration date
12/12/2024
Last updated
12/12/2024
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