Diana Louise Lewis, N.P.
Individual provider Active NPI Family Nurse Practitioner · Ocate, NM
NPI 1043201056 · NPPES record last updated Jun 27, 2011
Key facts
- NPI
- 1043201056
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- R24775 (NM)
- Practice address
- NM State Highway 120,
Mile Marker 12.5
Ocate, NM 87734 - Phone
- (505) 666-2475
- NPI assigned
- Oct 31, 2005
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R24775 | NM | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mesa Medical LLC | Family | Past | Accepting new patients |
| South Central Colfax County Special Hospital District | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | R24775 | NM | Yes |
Addresses
Primary practice location
NM State Highway 120,
Mile Marker 12.5
Ocate, NM 87734
Mailing address
NM Highway 120 @Mile Marker 12.5, South Side of Highway
P.O. Box 203
Ocate, NM 87734
Phone (505) 666-2475
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NM400019 | Other | NM | INDIVIDUAL PTAN |
| NMB2163 | Other | NM | GROUP PTAN NMB2163 |
| 22002570 | Medicaid | NM | |
| 41903765 | Medicaid | NM |
Other names
- Diana Louise Lewis
Other providers in Ocate, NM
All providers in Ocate, NM · Family Nurse Practitioner in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 27, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.