Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | R136634 | MD |
NPI | 1164754586 |
---|---|
Provider Name | Tryphena T Lewis |
First Address | Baltimore, MD 21202-2102 |
Second Address | Baltimore, MD 21202-2102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2010 |
Last Update Date | 30/07/2021 |