Healthcare Provider Details

I. General information

NPI: 1508336447
Provider Name (Legal Business Name): JULIA LEWIS APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2018
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4303 PITMAN ST # 4303
FORT SILL OK
73503-4473
US

IV. Provider business mailing address

21472 NE NORTH DR
FLETCHER OK
73541-3620
US

V. Phone/Fax

Practice location:
  • Phone: 580-585-5600
  • Fax:
Mailing address:
  • Phone: 631-790-1070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ00880600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number26NJ00880600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: