Provider Demographics
NPI:1629739784
Name:LEWIS, JULIE (BS,RN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:BS,RN
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:TEGELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:902 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:62896-2210
Mailing Address - Country:US
Mailing Address - Phone:618-937-6483
Mailing Address - Fax:618-937-1440
Practice Address - Street 1:2615 EDWARDS ST
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-3915
Practice Address - Country:US
Practice Address - Phone:618-462-2331
Practice Address - Fax:618-462-2504
Is Sole Proprietor?:No
Enumeration Date:2021-12-31
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041309896163WA0400X
MO2017004511163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163W00000XNursing Service ProvidersRegistered Nurse