Healthcare Provider Details

I. General information

NPI: 1124474408
Provider Name (Legal Business Name): LORELII O LEWIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LORELII ELIZABETH ODLAND

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 N 27TH ST
LINCOLN NE
68521-4752
US

IV. Provider business mailing address

PO BOX 860876
MINNEAPOLIS MN
55486-0876
US

V. Phone/Fax

Practice location:
  • Phone: 402-481-6343
  • Fax:
Mailing address:
  • Phone: 24-838-5904
  • Fax: 402-483-8599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36615
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: