Lewis Dale Fannon, RN, NP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

23521 Issued in CA

Practice address

50 Shrader St
San Francisco, CA 94117-1015

Phone

(415) 668-4166

NPI assigned

Aug 15, 2013

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Progress Foundation

  • Mental Illness Community Based Residential Treatment Facility
  • San Francisco, CA
  • NPI 1184788184
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1376524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548720000000",
    "number": "1063845832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "368 FELL ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941025144",
            "telephone_number": "415-861-0828",
            "fax_number": "415-861-0257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 SHRADER ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941171015",
            "telephone_number": "415-668-4166"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "52 Dore St",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941033828",
            "country_code": "US",
            "telephone_number": "415-553-3100",
            "fax_number": "415-553-3119",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FANNON",
        "first_name": "LEWIS",
        "middle_name": "DALE",
        "credential": "RN, NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-08-15",
        "last_updated": "2019-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "801999",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CA",
            "license": "23521",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zhi Fang
• John J Fangman, MD
• Jacqueline Alejandra Gaytan Fangonilo
• Charles Fann
• Laura E Fannon, PSYD INTERN
• Kelessery Yah Fanny, PHARMD
• Yehia Fanous
• Selome Fanta
• Heidi Yvonne Fantasia, RN, BSN
• Ainsley Marie Faraday, DPT, PT

• Adult Health Nurse Practitioner in San Francisco, CA
• Providers in San Francisco, CA by specialty
• Adult Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.