MEDICARE: MRS. HEATHER MARIE LEWIS FNP-C

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	363LF0000X	Family Nurse Practitioner	0024184793	VA

General Provider Information

NPI Number	:	1194453902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEATHER MARIE LEWIS FNP-C

Provider Business Mailing Address
First Line	:	3916 S CRATER RD
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23805-9202
Country	:	US
Telephone Number	:	804-526-4300
Fax Number	:	804-526-4337

Provider Business Practice Location Address
First Line	:	3916 S CRATER RD
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23805-9202
Country	:	US
Telephone Number	:	804-526-4300
Fax Number	:	804-526-4337

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

Provider Enumeration Date	:	08/10/2022
Last Update Date	:	01/14/2026

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