Healthcare Provider Details

I. General information

NPI: 1518883172
Provider Name (Legal Business Name): MR. LEWIS HEINLEIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 HERRICK ST STE 101
BEVERLY MA
01915-2734
US

IV. Provider business mailing address

36 WALLIS ST
BEVERLY MA
01915-4462
US

V. Phone/Fax

Practice location:
  • Phone: 978-927-4110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06261920
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: