MEDICARE: PAMELA LODELL 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	163WG0600X	Gerontology Registered Nurse	11030237	FL
2	363L00000X	Nurse Practitioner	11030237	FL

General Provider Information

NPI Number	:	1861244493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA LODELL LEWIS

Provider Business Mailing Address
First Line	:	265 COURTNEY LAKES CIR APT 201
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-2392
Country	:	US
Telephone Number	:	270-307-5940
Fax Number	:

Provider Business Practice Location Address
First Line	:	265 COURTNEY LAKES CIR APT 201
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-2392
Country	:	US
Telephone Number	:	270-307-5940
Fax Number	:

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

Provider Enumeration Date	:	04/05/2024
Last Update Date	:	04/05/2024

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Directions to “ PAMELA LODELL LEWIS ” Practice Location

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