Healthcare Provider Details

I. General information

NPI: 1316972011
Provider Name (Legal Business Name): JEAN H LEWIS BSN, APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR IVE 112D
MINNEAPOLIS MN
55417-2309
US

IV. Provider business mailing address

5452 GIRARD AVE S
MINNEAPOLIS MN
55419-1649
US

V. Phone/Fax

Practice location:
  • Phone: 612-467-3460
  • Fax: 612-467-2232
Mailing address:
  • Phone: 612-824-4663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number064844-6
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: