MEDICARE: ANJANETTE LEW

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	164W00000X	Licensed Practical Nurse	123101	OH

General Provider Information

NPI Number	:	1356839740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANJANETTE LEW

Provider Business Mailing Address
First Line	:	4213 BIDDULPH AVE # 1
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-5018
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4110 ROCKY RIVER DR
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44135-1175
Country	:	US
Telephone Number	:	216-609-5481
Fax Number	:

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

Provider Enumeration Date	:	05/01/2018
Last Update Date	:	05/01/2018

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Directions to “ ANJANETTE LEW ” Practice Location

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