Healthcare Provider Details

I. General information

NPI: 1861427742
Provider Name (Legal Business Name): MARYANNE LEWIS APRN,BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

7 GENNARO CIR
WAYLAND MA
01778-4436
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-5159
  • Fax:
Mailing address:
  • Phone: 508-653-3870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number119179
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: