Provider Demographics
NPI:1578929287
Name:LEWIS, TERESSA LYNN (RN)
Entity Type:Individual
Prefix:
First Name:TERESSA
Middle Name:LYNN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 DAYTON XENIA RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-6416
Mailing Address - Country:US
Mailing Address - Phone:937-429-7547
Mailing Address - Fax:937-429-7546
Practice Address - Street 1:2660 DAYTON XENIA RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-6416
Practice Address - Country:US
Practice Address - Phone:937-429-7547
Practice Address - Fax:937-429-7546
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 159182163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool