Doctor Name: | AMANDA LEWIS |
NPI Number: | 1033564844 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CPNP-PC |
License Number: | 5008530 |
Business Practice Address: | 101 Kellie Dr Smithfield, NC - 275779443 |
Business Phone Number: | 9199383749 |
Business Fax Number: | |
Mailing Address: | 101 Kellie Dr, SMITHFIELD |
State: | NC |
Postal Code: | 275779443 |
Phone Number: | 9199383749 |
Fax Number: | |
NPI Enumeration Date: | 04/29/2016 |
NPI Last Update Date: | 04/29/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0200X |
License Number: | 5008530 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |