Healthcare Provider Details

I. General information

NPI: 1013663988
Provider Name (Legal Business Name): HEATHER LEWIS DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 E SAVIDGE ST
SPRING LAKE MI
49456-1957
US

IV. Provider business mailing address

1728 PENNOYER AVE
GRAND HAVEN MI
49417-2395
US

V. Phone/Fax

Practice location:
  • Phone: 616-213-0253
  • Fax:
Mailing address:
  • Phone: 616-594-6128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704362080
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: