Healthcare Provider Details

I. General information

NPI: 1063044907
Provider Name (Legal Business Name): MRS. RACHAEL HINSON LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2020
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 DOCTORS DR
GREENVILLE SC
29605-5622
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-797-7060
  • Fax: 864-797-7065
Mailing address:
  • Phone: 803-522-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number24139
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: