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General NPI Number Information
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NPI Number | 1649528076
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Entity Type | Individual
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Provider Name | MRS. KATHRYN ELIZABETH LEWIS
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Gender | Female
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Dates
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Enumeration Date | 08/15/2012
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 15855 19 MILE RD
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City | CLINTON TWP
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State | MI
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Zip | 48038-3504
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Country | US
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Telephone | 800-532-2411
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Fax |
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Provider Business Mailing Address
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Address Line | 24211 LITTLE MACK AVE APT 2
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-1151
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Country | US
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Telephone | 586-498-0421
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Fax | 586-498-0421
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 4704252928
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704252928
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License Number State | MI
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