Provider Demographics
NPI:1619587904
Name:LEWIS, DANIELLE NICOLE (WHNP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:NICOLE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:WHNP
Mailing Address - Street 1:7535 CARPENTER FIRE STATION RD
Mailing Address - Street 2:STE 105
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-8969
Mailing Address - Country:US
Mailing Address - Phone:919-230-2100
Mailing Address - Fax:919-230-2133
Practice Address - Street 1:4551 NEW BERN AVE STE 160
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1552
Practice Address - Country:US
Practice Address - Phone:919-556-1008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5013379363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health