Provider Demographics
NPI:1437681210
Name:LEWIS, BRENDA FAYE (RN)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:FAYE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:BRENDA
Other - Middle Name:FAYE
Other - Last Name:BENJAMIN--LEWIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:123 ACORN AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-3503
Mailing Address - Country:US
Mailing Address - Phone:631-885-0089
Mailing Address - Fax:
Practice Address - Street 1:123 ACORN AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-3503
Practice Address - Country:US
Practice Address - Phone:631-885-0089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY402398-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse