MEDICARE: JULIE LEWIS ACCNS-AG

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	364SA2100X	Acute Care Clinical Nurse Specialist	2017038725	MO

General Provider Information

NPI Number	:	1790298990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE LEWIS ACCNS-AG

Provider Business Mailing Address
First Line	:	947 LOCKPORT DR
Second Line	:
City	:	CENTRALIA
State	:	MO
Zip	:	65240-4151
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	604 OLD 63 N
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65201-6308
Country	:	US
Telephone Number	:	573-499-6600
Fax Number	:

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

Provider Enumeration Date	:	11/09/2017
Last Update Date	:	11/09/2017

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