Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 7304 | CT |
N | 363LC1500X | Nurse Practitioner - Community Health | 320051 | NY |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 401200 | NY |
NPI | 1104846724 |
---|---|
Provider Name | Samantha Raquel Lewis |
First Address | Endicott, NY 13760-2634 |
Second Address | Pleasantville, NY 10570 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 23/07/2018 |