Provider Demographics
NPI:1093705907
Name:LEWIS, KATHERINE L (NP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:L
Last Name:LEWIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-2931
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:234 LITTLETON RD
Practice Address - Street 2:SUITE 2C
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-3596
Practice Address - Country:US
Practice Address - Phone:978-392-1900
Practice Address - Fax:978-392-9915
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA177498363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0386821Medicaid
MA0386821Medicaid
NP1465Medicare ID - Type Unspecified