Healthcare Provider Details

I. General information

NPI: 1962075739
Provider Name (Legal Business Name): MS. MARY LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 07/20/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 N 50TH ST APT 1001
TAMPA FL
33617-6122
US

IV. Provider business mailing address

8501 N 50TH ST APT 1001
TAMPA FL
33617-6122
US

V. Phone/Fax

Practice location:
  • Phone: 813-965-4456
  • Fax:
Mailing address:
  • Phone: 813-965-4456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: