MEDICARE: GAYLE Y. LEWIS WHCNP

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	363LW0102X	Women's Health Nurse Practitioner	080025187N7	OR

General Provider Information

NPI Number	:	1679650741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAYLE Y. LEWIS WHCNP

Provider Business Mailing Address
First Line	:	622 GROVE STREET
Second Line	:	P. O. BOX 1198
City	:	JACKSONVILLE
State	:	OREGON
Zip	:	97530
Country	:	UG
Telephone Number	:	541-899-7023
Fax Number	:

Provider Business Practice Location Address
First Line	:	622 GROVE STREET
Second Line	:
City	:	JACKSONVILLE
State	:	OR
Zip	:	97530-1198
Country	:	US
Telephone Number	:	541-899-7023
Fax Number	:

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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