Provider Demographics
NPI:1104015346
Name:LEWIS, SARAH LYN (RN)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:LYN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 ALHAMBRA PL
Mailing Address - Street 2:APT 2
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-4209
Mailing Address - Country:US
Mailing Address - Phone:608-271-1438
Mailing Address - Fax:
Practice Address - Street 1:205 ALHAMBRA PL
Practice Address - Street 2:APT 2
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-4209
Practice Address - Country:US
Practice Address - Phone:608-271-1438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI108058163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39929800Medicaid