Healthcare Provider Details

I. General information

NPI: 1619131893
Provider Name (Legal Business Name): ELIZABETH ANN LEWIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 STEVENS ST STE 300
GREENVILLE SC
29605-4528
US

IV. Provider business mailing address

5 STEVENS ST STE 300
GREENVILLE SC
29605-4528
US

V. Phone/Fax

Practice location:
  • Phone: 864-233-6338
  • Fax:
Mailing address:
  • Phone: 864-233-6338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number18508
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: