MEDICARE: MS. JUDITH ANN LEWIS R.N.

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	163WS0200X	School Registered Nurse	RN133058	AZ

General Provider Information

NPI Number	:	1689857930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUDITH ANN LEWIS R.N.

Provider Business Mailing Address
First Line	:	2140 E VIRGINIA AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-1324
Country	:	US
Telephone Number	:	602-381-6127
Fax Number	:	602-381-6125

Provider Business Practice Location Address
First Line	:	2140 E VIRGINIA AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-1324
Country	:	US
Telephone Number	:	602-381-6127
Fax Number	:	602-381-6125

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

Provider Enumeration Date	:	12/10/2007
Last Update Date	:	12/10/2007

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