Basic Information
| Provider Information | |||||||||
| NPI: | 1326339912 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | TONYA | ||||||||
| MiddleName: | RAE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28 COLORADO DR | ||||||||
| Address2: | |||||||||
| City: | HOUTZDALE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166518550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143425678 | ||||||||
| FaxNumber: | 8143420168 | ||||||||
| Practice Location | |||||||||
| Address1: | 1633 PHILIPSBURG BIGLER HWY | ||||||||
| Address2: | |||||||||
| City: | PHILIPSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168668112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143425678 | ||||||||
| FaxNumber: | 8143420168 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2011 | ||||||||
| LastUpdateDate: | 04/29/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | PN250595L | PA | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.