Healthcare Provider Details

I. General information

NPI: 1750922530
Provider Name (Legal Business Name): JAYLENE MARIE LEWIS NREMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2019
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 MOUNT TOBE RD
PLYMOUTH CT
06782-2803
US

IV. Provider business mailing address

140 MOUNT TOBE RD
PLYMOUTH CT
06782-2803
US

V. Phone/Fax

Practice location:
  • Phone: 860-417-0624
  • Fax:
Mailing address:
  • Phone: 860-417-0624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: