Provider Demographics
NPI:1114262029
Name:LEWIS, ELIZABETH MARIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MARIE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:M
Other - Last Name:NUNNENKAMP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:WHNP-BC
Mailing Address - Street 1:405 S CLAIRBORNE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1774
Mailing Address - Country:US
Mailing Address - Phone:913-730-3661
Mailing Address - Fax:913-768-1944
Practice Address - Street 1:407 S CLAIRBORNE RD STE 104
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1744
Practice Address - Country:US
Practice Address - Phone:913-648-2266
Practice Address - Fax:855-348-8430
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012024330363LW0102X
NE111418363L00000X
KS75719363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201139060BMedicaid