Healthcare Provider Details

I. General information

NPI: 1578563201
Provider Name (Legal Business Name): ANN A LEWIS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 FAIRVIEW ST
CLINTON NC
28328-2312
US

IV. Provider business mailing address

408 FAIRVIEW ST
CLINTON NC
28328-2312
US

V. Phone/Fax

Practice location:
  • Phone: 910-596-2400
  • Fax: 910-596-2502
Mailing address:
  • Phone: 910-596-2400
  • Fax: 910-596-2502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200386
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: