Healthcare Provider Details

I. General information

NPI: 1821760141
Provider Name (Legal Business Name): IYANA TAMISHA LEWIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 E 71ST ST # 4
NEW YORK NY
10021-4871
US

IV. Provider business mailing address

535 E 70TH ST
NEW YORK NY
10021-4823
US

V. Phone/Fax

Practice location:
  • Phone: 212-774-2837
  • Fax:
Mailing address:
  • Phone: 212-774-2837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number749977
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF349046-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: