Provider Demographics
NPI:1164409751
Name:LEWIS, NELLIE BRUNO (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:NELLIE
Middle Name:BRUNO
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CRNA
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Mailing Address - Street 1:3717 WALNUT BROOK DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-4069
Mailing Address - Country:US
Mailing Address - Phone:248-852-7902
Mailing Address - Fax:248-853-0671
Practice Address - Street 1:21230 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-2279
Practice Address - Country:US
Practice Address - Phone:586-880-2485
Practice Address - Fax:586-759-0237
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704097163367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered