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NPI Code Detail

MEDICARE: MS. PEACHES LEWIS RN

MEDICARE: MS. PEACHES LEWIS RN
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
1163WP0809XAdult Psychiatric/Mental Health Registered Nurse478729NY
2163W00000XRegistered Nurse478729NY

General Provider Information

NPI Number : 1174173462
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. PEACHES LEWIS RN
Provider Business Mailing Address
First Line : 681 CLARKSON AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11203-2199
Country : US
Telephone Number : 718-221-7823
Fax Number :
Provider Business Practice Location Address
First Line : 681 CLARKSON AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11203-2199
Country : US
Telephone Number : 718-221-7823
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2019
Last Update Date : 09/18/2019

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