Healthcare Provider Details

I. General information

NPI: 1841153723
Provider Name (Legal Business Name): JULIE ELIZABETH LEWIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9468 CHALKSTONE CRSE
BREWERTON NY
13029-8608
US

IV. Provider business mailing address

15 EMILY DR
AUBURN NY
13021-9138
US

V. Phone/Fax

Practice location:
  • Phone: 315-406-7112
  • Fax:
Mailing address:
  • Phone: 315-406-7112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number605077
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: