MEDICARE: MARY LEWIS

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	APRN684212	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669425732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY LEWIS

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE FL 2
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9342
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:

Provider Business Practice Location Address
First Line	:	15201 N CLEVELAND AVE STE 1010
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33903-2717
Country	:	US
Telephone Number	:	855-674-2500
Fax Number	:	239-599-4126

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	01/10/2024

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Directions to “ MARY LEWIS ” Practice Location

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