Healthcare Provider Details

I. General information

NPI: 1033353552
Provider Name (Legal Business Name): BILLIE LYNN LEWIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

792 GALLITZIN RD
CRESSON PA
16630-2213
US

IV. Provider business mailing address

818 HEMLOCK ST
GALLITZIN PA
16641-1223
US

V. Phone/Fax

Practice location:
  • Phone: 814-886-8161
  • Fax: 814-886-2955
Mailing address:
  • Phone: 814-932-0804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA002561L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: