Provider Demographics
NPI:1497466445
Name:LEWIS, AMY REBECCA
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:REBECCA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:REBECCA
Other - Last Name:CARDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11 BAYBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-2939
Mailing Address - Country:US
Mailing Address - Phone:315-567-1524
Mailing Address - Fax:
Practice Address - Street 1:11 BAYBERRY CIR
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-2939
Practice Address - Country:US
Practice Address - Phone:315-567-1524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY750950163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse