Healthcare Provider Details

I. General information

NPI: 1164754586
Provider Name (Legal Business Name): TRYPHENA T LEWIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2010
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 ST. PAUL PLACE DEPARTMENT OF PEDIATRICS
BALTIMORE MD
21202-2102
US

IV. Provider business mailing address

301 ST. PAUL PLACE MEDICAL STAFF SERVICES
BALTIMORE MD
21202-2102
US

V. Phone/Fax

Practice location:
  • Phone: 410-332-9594
  • Fax:
Mailing address:
  • Phone: 410-332-9407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR136634
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberR136634
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: