Provider Demographics
NPI:1750393609
Name:LEWIS, DEANNA L (PAC)
Entity type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:L
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2920 TELEGRAPH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2031
Mailing Address - Country:US
Mailing Address - Phone:510-561-0279
Mailing Address - Fax:
Practice Address - Street 1:446 N CAMPBELL AVE # 130
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-5660
Practice Address - Country:US
Practice Address - Phone:520-305-3900
Practice Address - Fax:888-972-1912
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ2971363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q10499Medicare UPIN