Healthcare Provider Details

I. General information

NPI: 1376776005
Provider Name (Legal Business Name): PATRICIA A LEWIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2009
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 N CAPITOL AVE STE 322
INDIANAPOLIS IN
46202-1476
US

IV. Provider business mailing address

250 N SHADELAND AVE STE 130 - PROVIDER ENROLLMENT
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-962-2929
  • Fax: 317-962-2070
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28143276A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number71003041A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: