MEDICARE: LYNDI MICHELLE 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	APN.0998481-NP	CO
2	363LF0000X	Family Nurse Practitioner	209027223	IL

General Provider Information

NPI Number	:	1295436921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNDI MICHELLE LEWIS FNP-C

Provider Business Mailing Address
First Line	:	4670 CADE CT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80922-1821
Country	:	US
Telephone Number	:	432-212-8753
Fax Number	:

Provider Business Practice Location Address
First Line	:	4670 CADE CT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80922-1821
Country	:	US
Telephone Number	:	432-212-8753
Fax Number	:

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

Provider Enumeration Date	:	03/10/2023
Last Update Date	:	07/11/2023

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