Healthcare Provider Details

I. General information

NPI: 1629207220
Provider Name (Legal Business Name): MARLA BRIEN LEWIS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 05/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2936 N ELM ST
LUMBERTON NC
28358-2981
US

IV. Provider business mailing address

2936 N ELM ST SUITE 102
LUMBERTON NC
28358-2981
US

V. Phone/Fax

Practice location:
  • Phone: 910-671-6619
  • Fax: 910-608-0487
Mailing address:
  • Phone: 910-671-6619
  • Fax: 910-608-0487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number194537
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: