Provider Demographics
NPI:1629207220
Name:LEWIS, MARLA BRIEN (NP-C)
Entity Type:Individual
Prefix:MISS
First Name:MARLA
Middle Name:BRIEN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2936 N ELM ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2981
Mailing Address - Country:US
Mailing Address - Phone:910-671-6619
Mailing Address - Fax:910-608-0487
Practice Address - Street 1:2936 N ELM ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2981
Practice Address - Country:US
Practice Address - Phone:910-671-6619
Practice Address - Fax:910-608-0487
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2012-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC194537363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health