MEDICARE: MRS. AMETHYST JADE 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
1	163WM0705X	Medical-Surgical Registered Nurse	NUR-RN-LIC-130547	MT

General Provider Information

NPI Number	:	1366253809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMETHYST JADE LEWIS RN

Provider Business Mailing Address
First Line	:	2922 UPPER HIGHWOOD DR
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102-0929
Country	:	US
Telephone Number	:	406-696-6863
Fax Number	:

Provider Business Practice Location Address
First Line	:	2922 UPPER HIGHWOOD DR
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102-0929
Country	:	US
Telephone Number	:	406-696-6863
Fax Number	:

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

Provider Enumeration Date	:	01/15/2025
Last Update Date	:	01/15/2025

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