Healthcare Provider Details

I. General information

NPI: 1780623975
Provider Name (Legal Business Name): PATRICIA LEWIS F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 PINE ST BLDG 4 SUITE 400
BRISTOL VT
05443-1043
US

IV. Provider business mailing address

61 PINE ST BLDG 4, SUITE 400
BRISTOL VT
05443-1043
US

V. Phone/Fax

Practice location:
  • Phone: 802-453-7422
  • Fax: 802-453-4815
Mailing address:
  • Phone: 802-453-7422
  • Fax: 802-453-4815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF332750
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101-0040354
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: