Healthcare Provider Details

I. General information

NPI: 1487769501
Provider Name (Legal Business Name): WENDY PAYNE LEWIS A.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7845 LITTLE AVE
CHARLOTTE NC
28226-8198
US

IV. Provider business mailing address

PO BOX 470408
CHARLOTTE NC
28247-0408
US

V. Phone/Fax

Practice location:
  • Phone: 704-375-0100
  • Fax: 704-335-3592
Mailing address:
  • Phone: 704-375-0100
  • Fax: 704-335-3592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number900353
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: