Provider Demographics
NPI:1871662635
Name:LEWIS, MICHELLE D (RN, CPNP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:D
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8606 VILLAGE DRIVE
Mailing Address - Street 2:STE A (NORTHEAST PEDIATRICS)
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217
Mailing Address - Country:US
Mailing Address - Phone:210-657-0220
Mailing Address - Fax:210-590-7288
Practice Address - Street 1:8606 VILLAGE DRIVE
Practice Address - Street 2:STE A
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217
Practice Address - Country:US
Practice Address - Phone:210-657-0220
Practice Address - Fax:210-590-7288
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX657566363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics