Healthcare Provider Details

I. General information

NPI: 1447347620
Provider Name (Legal Business Name): WYN LEWIS MA, MPH, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 SERENO DR
SANTA FE NM
87501-1536
US

IV. Provider business mailing address

214 SERENO DR
SANTA FE NM
87501-1536
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-3635
  • Fax: 505-983-2902
Mailing address:
  • Phone: 505-983-3635
  • Fax: 505-983-2902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number76121
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number093
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: