Healthcare Provider Details

I. General information

NPI: 1740725357
Provider Name (Legal Business Name): SHARON LEWIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2017
Last Update Date: 01/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 E NIZHONI BLVD
GALLUP NM
87301-5748
US

IV. Provider business mailing address

348 E BRICE ST
MONTPELIER IN
47359-1465
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-7000
  • Fax:
Mailing address:
  • Phone: 765-661-4629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number28164761A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: