Healthcare Provider Details

I. General information

NPI: 1972567956
Provider Name (Legal Business Name): MICHELLE D LEWIS FNP, ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 BREN RD EAST MAIL ROUTE MN 008-B213
MINNETONKA MN
55343-9664
US

IV. Provider business mailing address

4408 EATON CIR
COLLEYVILLE TX
76034-4652
US

V. Phone/Fax

Practice location:
  • Phone: 817-368-1565
  • Fax: 817-416-0145
Mailing address:
  • Phone: 817-368-1565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number606929
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP112278
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: