MEDICARE: LLILLY BRISTER-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	251J00000X	Nursing Care Agency	025722	MO

General Provider Information

NPI Number	:	1184168320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LLILLY BRISTER-LEWIS

Provider Business Mailing Address
First Line	:	3470 HAMPTON AVE
Second Line	:	101-B
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-1946
Country	:	US
Telephone Number	:	314-620-7905
Fax Number	:	314-487-5830

Provider Business Practice Location Address
First Line	:	3470 HAMPTON AVE
Second Line	:	101-B
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-1946
Country	:	US
Telephone Number	:	314-620-7905
Fax Number	:	314-487-5830

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

Provider Enumeration Date	:	12/07/2016
Last Update Date	:	12/07/2016

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Directions to “ LLILLY BRISTER-LEWIS ” Practice Location

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