Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 5008530 | NC |
NPI | 1033564844 |
---|---|
Provider Name | Amanda Lewis |
First Address | Durham, NC 27705-4504 |
Second Address | Durham, NC 27705-4504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2016 |
Last Update Date | 14/11/2016 |