Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 4704196130 | MI |
NPI | 1023460367 |
---|---|
Provider Name | Jennifer Emily Lewis |
First Address | Adrian, MI 49221 |
Second Address | Adrian, MI 49221-1561 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2016 |
Last Update Date | 24/02/2017 |