MEDICARE: MS. ELNORA LEWIS CRNP

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	363L00000X	Nurse Practitioner	RN33167	DC
2	363L00000X	Nurse Practitioner	R088841	MD
3	363LW0102X	Women's Health Nurse Practitioner	RN33167	DC

General Provider Information

NPI Number	:	1053471664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELNORA LEWIS CRNP

Provider Business Mailing Address
First Line	:	2101 E JEFFERSON ST
Second Line	:	KAISER PERMANENTE MEDICARE ENROLLMENT
City	:	ROCKVILLE
State	:	MD
Zip	:	20852-4908
Country	:	US
Telephone Number	:	301-816-2424
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 17TH ST NE
Second Line	:	FAMILY HEALTH AND BIRTH CENTER
City	:	WASHINGTON
State	:	DC
Zip	:	20002-7200
Country	:	US
Telephone Number	:	202-398-5520
Fax Number	:

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	12/06/2012

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