MEDICARE: MAGGIE LEWIS FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	2014004544	MO
2	363L00000X	Nurse Practitioner	209.014868	IL

General Provider Information

NPI Number	:	1023433745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAGGIE LEWIS FNP-C

Provider Business Mailing Address
First Line	:	3433 NORTH HIGHWAY 67
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033
Country	:	US
Telephone Number	:	314-755-1822
Fax Number	:

Provider Business Practice Location Address
First Line	:	3433 N HWY 67
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033
Country	:	US
Telephone Number	:	314-755-1822
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2014
Last Update Date	:	10/17/2016

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Directions to “ MAGGIE LEWIS FNP-C” Practice Location

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