Healthcare Provider Details

I. General information

NPI: 1033506027
Provider Name (Legal Business Name): AMBER LEWIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 PAUL MAILLARD RD STE. D-1900
LULING LA
70070-4349
US

IV. Provider business mailing address

PO BOX 4176
HOUMA LA
70361-4176
US

V. Phone/Fax

Practice location:
  • Phone: 985-308-1604
  • Fax: 985-308-1605
Mailing address:
  • Phone: 985-872-5864
  • Fax: 985-872-0317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP08185
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: