MEDICARE: ANNETTE LEWIS

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	RN58717	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164488144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNETTE LEWIS

Provider Business Mailing Address
First Line	:	PO BOX 1168
Second Line	:
City	:	JAMESTOWN
State	:	TN
Zip	:	38556-1168
Country	:	US
Telephone Number	:	931-879-8139
Fax Number	:	931-879-0221

Provider Business Practice Location Address
First Line	:	234 W CENTRAL AVE
Second Line	:
City	:	JAMESTOWN
State	:	TN
Zip	:	38556-3405
Country	:	US
Telephone Number	:	931-879-8139
Fax Number	:	931-879-0221

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	08/27/2007

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Directions to “ ANNETTE LEWIS ” Practice Location

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