Healthcare Provider Details

I. General information

NPI: 1356420954
Provider Name (Legal Business Name): KRISTIE MILLER LEWIS RNC, NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL CENTER BLVD
WINSTON-SALEM NC
27157
US

IV. Provider business mailing address

5104 CLAIREMONT DR
BROWNS SUMMIT NC
27214-9015
US

V. Phone/Fax

Practice location:
  • Phone: 336-713-6509
  • Fax: 336-713-6434
Mailing address:
  • Phone: 336-656-7089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: