Provider Demographics
NPI:1518036607
Name:LEWIS, TAMMY (GNP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14883
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-4883
Mailing Address - Country:US
Mailing Address - Phone:336-274-3241
Mailing Address - Fax:336-544-2343
Practice Address - Street 1:301 E WENDOVER AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1230
Practice Address - Country:US
Practice Address - Phone:336-274-3241
Practice Address - Fax:336-544-2343
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC600064363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC500009457Medicare PIN
NC2596413BMedicare PIN
S53295Medicare UPIN