Healthcare Provider Details

I. General information

NPI: 1184299026
Provider Name (Legal Business Name): TAMMY FAYE LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N BURHANS BLVD
HAGERSTOWN MD
21740-4677
US

IV. Provider business mailing address

2628 CASTLEGREEN DR
GREENCASTLE PA
17225-9299
US

V. Phone/Fax

Practice location:
  • Phone: 301-791-2660
  • Fax:
Mailing address:
  • Phone: 717-729-1470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR139829
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: