Provider Demographics
NPI:1699821686
Name:LEWIS, KATHRYN J
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:J
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 SILVER RD
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5831
Mailing Address - Country:US
Mailing Address - Phone:207-942-4186
Mailing Address - Fax:
Practice Address - Street 1:223 SILVER RD
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5831
Practice Address - Country:US
Practice Address - Phone:207-942-4186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor