Provider Demographics
NPI:1043751209
Name:LEWIS, BRITTANY
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HARTVILLE
Mailing Address - State:WY
Mailing Address - Zip Code:82215-9703
Mailing Address - Country:US
Mailing Address - Phone:307-399-5823
Mailing Address - Fax:
Practice Address - Street 1:3110 W C ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-1604
Practice Address - Country:US
Practice Address - Phone:307-532-7068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY37213163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse