Healthcare Provider Details

I. General information

NPI: 1215790068
Provider Name (Legal Business Name): VANESSA RENAY LEWIS MSN, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 04/09/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4226 E US HIGHWAY 64-ALT
MURPHY NC
28906-6966
US

IV. Provider business mailing address

PO BOX 100181
COLUMBIA SC
29202-3141
US

V. Phone/Fax

Practice location:
  • Phone: 828-479-6434
  • Fax:
Mailing address:
  • Phone: 828-202-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number5019584
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: