Healthcare Provider Details

I. General information

NPI: 1710917596
Provider Name (Legal Business Name): SUSAN JANE LEWIS ARNP, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ZORN AVE
LOUISVILLE KY
40206-1433
US

IV. Provider business mailing address

203 N HUBBARDS LN
LOUISVILLE KY
40207-2250
US

V. Phone/Fax

Practice location:
  • Phone: 502-287-4000
  • Fax:
Mailing address:
  • Phone: 502-894-0881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number1024034/ 2157S
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: