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NPI Code Detail

MEDICARE: MS. JESSICA E LEWIS CRNA

MEDICARE: MS. JESSICA E LEWIS CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist149537MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093717134
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JESSICA E LEWIS CRNA
Provider Business Mailing Address
First Line : 660 S EUCLID AVE
Second Line : CB 8054
City : SAINT LOUIS
State : MO
Zip : 63110-1010
Country : US
Telephone Number : 800-862-9980
Fax Number : 314-362-1185
Provider Business Practice Location Address
First Line : 12634 OLIVE BLVD
Second Line : DEPT ANESTHESIOLOGY
City : SAINT LOUIS
State : MO
Zip : 63141-6337
Country : US
Telephone Number : 800-862-9980
Fax Number : 314-362-1185
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2005
Last Update Date : 11/15/2021

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