Healthcare Provider Details

I. General information

NPI: 1427004324
Provider Name (Legal Business Name): DALEEN L LEWIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 04/28/2020
Certification Date: 04/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2645 MERIDIAN PKWY STE 323
DURHAM NC
27713-4232
US

IV. Provider business mailing address

949 PINEY FOREST RD
DANVILLE VA
24540-1591
US

V. Phone/Fax

Practice location:
  • Phone: 984-227-8902
  • Fax:
Mailing address:
  • Phone: 434-835-4876
  • Fax: 434-835-4875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024166073
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: