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General NPI Number Information
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NPI Number | 1841065760
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Entity Type | Individual
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Provider Name | TARA LEWIS FNP-C
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Gender | Female
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Dates
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Enumeration Date | 11/21/2023
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 4706 PRODUCT DR
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City | WIXOM
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State | MI
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Zip | 48393-2071
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Country | US
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Telephone | 248-567-2334
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Fax |
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Provider Business Mailing Address
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Address Line | 3845 AUDREY RAE LN
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City | HOWELL
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State | MI
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Zip | 48843-6607
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Country | US
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Telephone |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704295516
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704295516
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License Number State | MI
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