Healthcare Provider Details

I. General information

NPI: 1003147513
Provider Name (Legal Business Name): MARY P BARNETT-LEWIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 N MARQUETTE ST
MADISON WI
53704-5150
US

IV. Provider business mailing address

238 N MARQUETTE ST
MADISON WI
53704-5150
US

V. Phone/Fax

Practice location:
  • Phone: 608-245-0693
  • Fax:
Mailing address:
  • Phone: 608-245-0693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number112288-030
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number112288-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: