Provider Demographics
NPI:1235453721
Name:LEWIS, AMY CATHERINE DEMAREE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:CATHERINE DEMAREE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1355
Mailing Address - Street 2:5588 TUCKER RD
Mailing Address - City:COLLEGEDALE
Mailing Address - State:TN
Mailing Address - Zip Code:37315-1355
Mailing Address - Country:US
Mailing Address - Phone:423-504-5669
Mailing Address - Fax:423-504-5669
Practice Address - Street 1:5588 TUCKER RD
Practice Address - Street 2:DEPARTMENT OF SURGERY
Practice Address - City:COLLEGEDALE
Practice Address - State:TN
Practice Address - Zip Code:37315-1396
Practice Address - Country:US
Practice Address - Phone:423-504-5669
Practice Address - Fax:419-783-4416
Is Sole Proprietor?:No
Enumeration Date:2010-03-26
Last Update Date:2011-11-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNAPN0000014687367500000X
KY6372A367500000X
GARN188003367500000X
OHCOA.11444-NA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP00962529Medicare Oscar/Certification