Provider Demographics
NPI:1366466211
Name:LEWIS, JEFFREY DAVID (NP)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:DAVID
Last Name:LEWIS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 CAPEN RD
Mailing Address - Street 2:
Mailing Address - City:GARDINER
Mailing Address - State:ME
Mailing Address - Zip Code:04345-6510
Mailing Address - Country:US
Mailing Address - Phone:207-582-3448
Mailing Address - Fax:
Practice Address - Street 1:1 VA CTR
Practice Address - Street 2:BLD 200 RM 452
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-6719
Practice Address - Country:US
Practice Address - Phone:207-623-8411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEP00360146L00000X
MER028292363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health