Healthcare Provider Details

I. General information

NPI: 1922550524
Provider Name (Legal Business Name): BRIDGETTE M. LEWIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2016
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 WOODVIEW TRL
AURORA OH
44202-7838
US

IV. Provider business mailing address

445 WOODVIEW TRL
AURORA OH
44202-7838
US

V. Phone/Fax

Practice location:
  • Phone: 216-310-2479
  • Fax:
Mailing address:
  • Phone: 216-310-2479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN361531
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN361531
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN361531
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN361531
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN361531
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: