Healthcare Provider Details

I. General information

NPI: 1366466211
Provider Name (Legal Business Name): JEFFREY DAVID LEWIS NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VA CTR BLD 200 RM 452
AUGUSTA ME
04330-6719
US

IV. Provider business mailing address

256 CAPEN RD
GARDINER ME
04345-6510
US

V. Phone/Fax

Practice location:
  • Phone: 207-623-8411
  • Fax:
Mailing address:
  • Phone: 207-582-3448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberP00360
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR028292
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: