Healthcare Provider Details

I. General information

NPI: 1427457654
Provider Name (Legal Business Name): CHRISTIN LEWIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2014
Last Update Date: 08/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 E MAIN ST
PARK HILLS MO
63601-2624
US

IV. Provider business mailing address

PO BOX 506
PARK HILLS MO
63601-0506
US

V. Phone/Fax

Practice location:
  • Phone: 573-431-0554
  • Fax: 573-431-6580
Mailing address:
  • Phone: 573-431-0554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2008021827
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: