Provider Demographics
NPI:1578541314
Name:LEWISH, SUSAN B (GNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:B
Last Name:LEWISH
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 1:1500 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621
Mailing Address - Country:US
Mailing Address - Phone:585-697-6469
Mailing Address - Fax:585-342-9166
Practice Address - Street 1:1500 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621
Practice Address - Country:US
Practice Address - Phone:585-697-6469
Practice Address - Fax:585-342-9166
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3405171363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
171775BJOtherPREFERRED CARE
P52079Medicare UPIN
DD0993Medicare ID - Type UnspecifiedST ANNES
DD00994Medicare ID - Type UnspecifiedHERITAGE
RA8021Medicare ID - Type UnspecifiedSACMP