Provider Demographics
NPI:1508198094
Name:LEWIS, BRYAN ANTHONY (CNP)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:ANTHONY
Last Name:LEWIS
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 MIDAY AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641-8934
Mailing Address - Country:US
Mailing Address - Phone:330-875-4935
Mailing Address - Fax:330-499-4190
Practice Address - Street 1:6512 WHIPPLE AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7340
Practice Address - Country:US
Practice Address - Phone:330-499-5600
Practice Address - Fax:330-499-4190
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11272363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily