Provider Demographics
NPI:1740418383
Name:LEWIS, LINDA CAROLYN (RN)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:CAROLYN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25140 LAHSER RD
Mailing Address - Street 2:SUITE 232
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-2753
Mailing Address - Country:US
Mailing Address - Phone:248-208-0553
Mailing Address - Fax:248-208-0558
Practice Address - Street 1:25140 LAHSER RD
Practice Address - Street 2:SUITE 232
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-2753
Practice Address - Country:US
Practice Address - Phone:248-208-0553
Practice Address - Fax:248-208-0558
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704099679163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse