Healthcare Provider Details

I. General information

NPI: 1568829109
Provider Name (Legal Business Name): MANDI E LEW CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2016
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 COMMERCIAL WAY STE 140
ROCK SPRINGS WY
82901-4750
US

IV. Provider business mailing address

3000 COLLEGE DR
ROCK SPRINGS WY
82901-4202
US

V. Phone/Fax

Practice location:
  • Phone: 435-755-6061
  • Fax: 307-448-2250
Mailing address:
  • Phone: 307-362-1861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number22001.1483
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: