Healthcare Provider Details

I. General information

NPI: 1871685040
Provider Name (Legal Business Name): LYNN LEWIS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 DEXTER ST
MILAN MI
48160-1160
US

IV. Provider business mailing address

2100 COMMONWEALTH BLVD SUITE 202
ANN ARBOR MI
48105-1593
US

V. Phone/Fax

Practice location:
  • Phone: 734-439-2429
  • Fax: 734-439-0200
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704133792
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: