Provider Demographics
NPI:1205694023
Name:LEWIS, JENNY LYNN
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:LYNN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2172 W BELLA LN
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-4897
Mailing Address - Country:US
Mailing Address - Phone:208-513-6857
Mailing Address - Fax:
Practice Address - Street 1:2172 W BELLA LN
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-4897
Practice Address - Country:US
Practice Address - Phone:208-513-6857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care