Provider Demographics
NPI:1588188122
Name:LEWIS, JENNIFER J (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:LEWIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:J
Other - Last Name:LUNDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4897 BENNETTS PASTURE RD.
Mailing Address - Street 2:PO BOX 5312
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435
Mailing Address - Country:US
Mailing Address - Phone:571-425-1881
Mailing Address - Fax:
Practice Address - Street 1:501 BAYLOR CT STE 200
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3690
Practice Address - Country:US
Practice Address - Phone:757-993-2273
Practice Address - Fax:757-267-5589
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR184603363LF0000X
VA0024174863363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily