=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376800011
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NP LEWIS ADULT HEALTH CARE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2012
-----------------------------------------------------
Last Update Date | 04/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 463 MAXWELL ST
-----------------------------------------------------
City | WEST HEMPSTEAD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11552-1920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-325-5995
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 463 MAXWELL ST
-----------------------------------------------------
City | WEST HEMPSTEAD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11552-1920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-325-5995
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER
-----------------------------------------------------
Name | LISA LEWIS
-----------------------------------------------------
Credential | ANP
-----------------------------------------------------
Telephone | 516-325-5995
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------