Healthcare Provider Details

I. General information

NPI: 1114262029
Provider Name (Legal Business Name): ELIZABETH MARIE LEWIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH M. NUNNENKAMP WHNP-BC

II. Dates (important events)

Enumeration Date: 12/04/2012
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 S CLAIRBORNE RD STE 104
OLATHE KS
66062-1744
US

IV. Provider business mailing address

405 S CLAIRBORNE RD STE 2
OLATHE KS
66062-1774
US

V. Phone/Fax

Practice location:
  • Phone: 913-648-2266
  • Fax: 855-348-8430
Mailing address:
  • Phone: 913-730-3661
  • Fax: 913-768-1944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number111418
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2012024330
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number75719
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: