MEDICARE: DR. ELLEN MINA LEWIS N.D.

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	175F00000X	Naturopath	1838	OR
2	175F00000X	Naturopath	000493	CT

General Provider Information

NPI Number	:	1972887511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLEN MINA LEWIS N.D.

Provider Business Mailing Address
First Line	:	PO BOX 4065
Second Line	:
City	:	MONROE
State	:	CT
Zip	:	06468-4065
Country	:	US
Telephone Number	:	203-916-4600
Fax Number	:	203-916-4601

Provider Business Practice Location Address
First Line	:	260 RIVERSIDE AVE
Second Line	:
City	:	WESTPORT
State	:	CT
Zip	:	06880-4804
Country	:	US
Telephone Number	:	203-916-4600
Fax Number	:	203-416-9601

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

Provider Enumeration Date	:	09/30/2011
Last Update Date	:	01/05/2014

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