Provider Demographics
NPI:1164436978
Name:LEWIS, CHERYL ANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5225 E RIVER RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-1103
Mailing Address - Country:US
Mailing Address - Phone:716-983-1957
Mailing Address - Fax:
Practice Address - Street 1:5225 E RIVER RD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072-1103
Practice Address - Country:US
Practice Address - Phone:716-983-1957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331381363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02664491Medicaid
NYRA6847Medicare ID - Type UnspecifiedINDV.MEDICARE #FOR GROUP
NY02664491Medicaid