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NPI Code Detail

MEDICARE: MRS. NELLIE BRUNO LEWIS CRNA

MEDICARE: MRS. NELLIE BRUNO LEWIS CRNA
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
1367500000XCertified Registered Nurse Anesthetist4704097163MI

General Provider Information

NPI Number : 1164409751
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NELLIE BRUNO LEWIS CRNA
Provider Business Mailing Address
First Line : 3717 WALNUT BROOK DR
Second Line :
City : ROCHESTER HILLS
State : MI
Zip : 48309-4069
Country : US
Telephone Number : 248-852-7902
Fax Number : 248-853-0671
Provider Business Practice Location Address
First Line : 21230 DEQUINDRE RD
Second Line :
City : WARREN
State : MI
Zip : 48091-2279
Country : US
Telephone Number : 586-880-2485
Fax Number : 586-759-0237
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2005
Last Update Date : 07/08/2007

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