Basic Information
| Provider Information | |||||||||
| NPI: | 1689130403 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | ROSANN | ||||||||
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| Credential: | CNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8650 MEMORY LN | ||||||||
| Address2: | |||||||||
| City: | WINNEMUCCA | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894456661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7754033247 | ||||||||
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| Practice Location | |||||||||
| Address1: | 118 E HASKELL ST | ||||||||
| Address2: | |||||||||
| City: | WINNEMUCCA | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894453247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7756235222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2019 | ||||||||
| LastUpdateDate: | 06/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WM0705X | 821055 | NV | N | Nursing Service Providers | Registered Nurse | Medical-Surgical | 376K00000X | CNA032875 | NV | Y | Nursing Service Related Providers | Nurse's Aide |
ID Information
| ID | Type | State | Issuer | Description | 821055 | 01 | NV | STATE BOARD OF NURSING NEVADA REGISTERED NURSE | OTHER | CNA032875 | 01 | NV | STATE BOARD OF NURSING | OTHER |