Healthcare Provider Details

I. General information

NPI: 1427154624
Provider Name (Legal Business Name): PATRICIA LEWIS A.P.R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PATRICIA SHUTT

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 MARILYN AVE
ST AUGUSTINE FL
32080-5345
US

IV. Provider business mailing address

13 MARILYN AVE
ST AUGUSTINE FL
32080-5345
US

V. Phone/Fax

Practice location:
  • Phone: 617-407-6527
  • Fax:
Mailing address:
  • Phone: 617-407-6527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number162923
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: