Provider Demographics
NPI:1639131949
Name:LEWIS, ELLEN G (FNP)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:G
Last Name:LEWIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 WINGS NECK RD
Mailing Address - Street 2:
Mailing Address - City:POCASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02559-1708
Mailing Address - Country:US
Mailing Address - Phone:508-563-6833
Mailing Address - Fax:508-748-2590
Practice Address - Street 1:240 WAREHAM RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:MA
Practice Address - Zip Code:02738-1175
Practice Address - Country:US
Practice Address - Phone:508-748-1313
Practice Address - Fax:508-748-2590
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA229070363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily