Provider Demographics
NPI:1174689855
Name:LEWIS, ANN MARIE
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
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:PO BOX 3407
Mailing Address - Street 2:
Mailing Address - City:ARIZONA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85223-3407
Mailing Address - Country:US
Mailing Address - Phone:520-466-1315
Mailing Address - Fax:
Practice Address - Street 1:8682 W RAVEN DR
Practice Address - Street 2:
Practice Address - City:ARIZONA CITY
Practice Address - State:AZ
Practice Address - Zip Code:85223
Practice Address - Country:US
Practice Address - Phone:520-466-1315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10283385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child