Provider Demographics
NPI:1033844683
Name:WHITTIER-LEWIS, CERRISA PATRICE (BSN)
Entity Type:Individual
Prefix:
First Name:CERRISA
Middle Name:PATRICE
Last Name:WHITTIER-LEWIS
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 SUNSHINE BROOK DR
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-8964
Mailing Address - Country:US
Mailing Address - Phone:314-218-5126
Mailing Address - Fax:
Practice Address - Street 1:545 SUNSHINE BROOK DR
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-8964
Practice Address - Country:US
Practice Address - Phone:314-218-5126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018018774163WC0200X, 163W00000X, 163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical