MEDICARE: MS. ELLEN G LEWIS FNP

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	229070	MA

General Provider Information

NPI Number	:	1639131949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELLEN G LEWIS FNP

Provider Business Mailing Address
First Line	:	35 WINGS NECK RD
Second Line	:
City	:	POCASSET
State	:	MA
Zip	:	02559-1708
Country	:	US
Telephone Number	:	508-563-6833
Fax Number	:	508-748-2590

Provider Business Practice Location Address
First Line	:	240 WAREHAM RD
Second Line	:
City	:	MARION
State	:	MA
Zip	:	02738-1175
Country	:	US
Telephone Number	:	508-748-1313
Fax Number	:	508-748-2590

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

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	02/06/2012

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