Healthcare Provider Details

I. General information

NPI: 1770475063
Provider Name (Legal Business Name): MICHELLE LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2025
Last Update Date: 07/19/2025
Certification Date: 07/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26317 WASHINGTON ST
NORTH DINWIDDIE VA
23803-2727
US

IV. Provider business mailing address

PO BOX 34382
NORTH CHESTERFIELD VA
23234-0382
US

V. Phone/Fax

Practice location:
  • Phone: 804-524-7000
  • Fax:
Mailing address:
  • Phone: 804-536-4050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number24194082
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: