Provider Demographics
NPI:1528406824
Name:LEWIS, ARLENE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:ARLENE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 BROOKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:NY
Mailing Address - Zip Code:11575-1901
Mailing Address - Country:US
Mailing Address - Phone:516-771-8489
Mailing Address - Fax:
Practice Address - Street 1:127 BROOKSIDE AVE
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:NY
Practice Address - Zip Code:11575-1901
Practice Address - Country:US
Practice Address - Phone:516-771-8489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY424778163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse