Provider Demographics
NPI:1245225804
Name:LEWIS, MARSHA (ARNP)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 N SUNSET
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:KS
Mailing Address - Zip Code:67878
Mailing Address - Country:US
Mailing Address - Phone:620-384-5439
Mailing Address - Fax:620-274-4729
Practice Address - Street 1:113 S MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:ULYSSES
Practice Address - State:KS
Practice Address - Zip Code:67880-2519
Practice Address - Country:US
Practice Address - Phone:620-356-2432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44876363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS161288OtherBC/BS PROVIDER NUMBER
KS4287299002Medicaid
KS171810Medicare PIN
KS161288OtherBC/BS PROVIDER NUMBER
KS4287299002Medicaid
KS171813Medicare PIN
KS171814Medicare PIN