Provider Demographics
NPI:1366206237
Name:LEWIS, REBECCA ANN (FNP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1920 BOWLING GREEN DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-3417
Mailing Address - Country:US
Mailing Address - Phone:916-397-9718
Mailing Address - Fax:
Practice Address - Street 1:3840 WATT AVE BLDG E
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-2640
Practice Address - Country:US
Practice Address - Phone:916-488-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028608207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine