Provider Demographics
NPI:1598078388
Name:LEWIS, BRENDA (LPN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4566 162ND ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3158
Mailing Address - Country:US
Mailing Address - Phone:718-539-8044
Mailing Address - Fax:718-539-8045
Practice Address - Street 1:4566 162ND ST
Practice Address - Street 2:SUITE 1
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-3158
Practice Address - Country:US
Practice Address - Phone:718-539-8044
Practice Address - Fax:718-539-8045
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228960164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse