Healthcare Provider Details

I. General information

NPI: 1639131949
Provider Name (Legal Business Name): ELLEN G LEWIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 02/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 WAREHAM RD
MARION MA
02738-1175
US

IV. Provider business mailing address

35 WINGS NECK RD
POCASSET MA
02559-1708
US

V. Phone/Fax

Practice location:
  • Phone: 508-748-1313
  • Fax: 508-748-2590
Mailing address:
  • Phone: 508-563-6833
  • Fax: 508-748-2590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number229070
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: