Healthcare Provider Details

I. General information

NPI: 1093705907
Provider Name (Legal Business Name): KATHERINE L LEWIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 LITTLETON RD SUITE 2C
WESTFORD MA
01886-3596
US

IV. Provider business mailing address

20 CENTER ST
WOBURN MA
01801-2931
US

V. Phone/Fax

Practice location:
  • Phone: 978-392-1900
  • Fax: 978-392-9915
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number177498
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: