Provider Demographics
NPI:1710237565
Name:LEWIS, KAREN SUE (NP)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:SUE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8695 ROYALE OAK CT
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6900
Mailing Address - Country:US
Mailing Address - Phone:440-796-9023
Mailing Address - Fax:
Practice Address - Street 1:8316 YELLOWBRICK RD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4960
Practice Address - Country:US
Practice Address - Phone:440-796-9023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN293968363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily