Healthcare Provider Details

I. General information

NPI: 1699141259
Provider Name (Legal Business Name): AYLA LEWIS CARR FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AYLA ANNE LEWIS

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 VT ROUTE 149
WEST PAWLET VT
05775-9798
US

IV. Provider business mailing address

41 HILLCREST DR
BARKHAMSTED CT
06063-1121
US

V. Phone/Fax

Practice location:
  • Phone: 802-645-0580
  • Fax: 802-645-0587
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2283356
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: