MEDICARE: MRS. TONYA DOLORES LEWIS NBC-HWC

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
1	164W00000X	Licensed Practical Nurse	PN5180812	FL
2	171400000X	Health & Wellness Coach	A-3197173	FL

General Provider Information

NPI Number	:	1407434111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TONYA DOLORES LEWIS NBC-HWC

Provider Business Mailing Address
First Line	:	6845 HENDRY DR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-7468
Country	:	US
Telephone Number	:	561-370-9373
Fax Number	:

Provider Business Practice Location Address
First Line	:	6845 HENDRY DR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-7468
Country	:	US
Telephone Number	:	561-370-9373
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2021
Last Update Date	:	04/01/2021

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