Healthcare Provider Details

I. General information

NPI: 1891079802
Provider Name (Legal Business Name): AMY SUE LEWIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2011
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34855 N JAMES AVE
INGLESIDE IL
60041-9574
US

IV. Provider business mailing address

34855 N JAMES AVE
INGLESIDE IL
60041-9574
US

V. Phone/Fax

Practice location:
  • Phone: 224-406-2755
  • Fax: 262-577-8399
Mailing address:
  • Phone: 224-406-2755
  • Fax: 262-577-8399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number085207
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: