Healthcare Provider Details

I. General information

NPI: 1164194197
Provider Name (Legal Business Name): ANDREA MONTANA LEWIS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MESSIMER DR
NEWARK OH
43055-1841
US

IV. Provider business mailing address

1320 W MAIN ST
NEWARK OH
43055-1822
US

V. Phone/Fax

Practice location:
  • Phone: 220-564-4677
  • Fax:
Mailing address:
  • Phone: 220-564-4677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: