Provider Demographics
NPI:1700403037
Name:LEWIS, MOLLY (APRN)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1145 S UTICA AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4013
Mailing Address - Country:US
Mailing Address - Phone:918-579-3825
Mailing Address - Fax:
Practice Address - Street 1:9001 S 101ST EAST AVE STE 230
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5797
Practice Address - Country:US
Practice Address - Phone:918-392-5411
Practice Address - Fax:918-615-3465
Is Sole Proprietor?:No
Enumeration Date:2020-07-02
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK136240363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner