Provider Demographics
NPI:1871795476
Name:LEWIS, ANNETTE M (LDEM, CPM)
Entity type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:M
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LDEM, CPM
Other - Prefix:MRS
Other - First Name:ANNETTE
Other - Middle Name:M
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LM
Mailing Address - Street 1:520 16TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-3538
Mailing Address - Country:US
Mailing Address - Phone:208-467-1230
Mailing Address - Fax:
Practice Address - Street 1:520 16TH AVE N
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-3538
Practice Address - Country:US
Practice Address - Phone:208-467-1230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMID-23176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDMID-23OtherLICENSED MIDWIFE