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General NPI Number Information
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NPI Number | 1003790197
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Entity Type | Individual
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Provider Name | SUSSETT B CAIN-LEWIS
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Gender | Female
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Dates
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Enumeration Date | 08/02/2025
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Last Update Date | 08/02/2025
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Provider Practice Location Address
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Address Line | 409 EASTON RD
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City | WILLOW GROVE
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State | PA
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Zip | 19090-2529
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Country | US
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Telephone | 267-915-0261
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Fax |
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Provider Business Mailing Address
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Address Line | 7904 RODGERS RD
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City | ELKINS PARK
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State | PA
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Zip | 19027-1219
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Country | US
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Telephone | 215-514-4989
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | SPO33041
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License Number State | PA
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