Provider Demographics
NPI:1881653913
Name:LEWIS, NANCY J (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:J
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-1578
Mailing Address - Country:US
Mailing Address - Phone:740-532-3534
Mailing Address - Fax:740-532-0027
Practice Address - Street 1:10777 COUNTY ROAD 107
Practice Address - Street 2:
Practice Address - City:PROCTORVILLE
Practice Address - State:OH
Practice Address - Zip Code:45669-8130
Practice Address - Country:US
Practice Address - Phone:740-302-0541
Practice Address - Fax:740-886-0255
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP03155363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7102345000Medicaid
OH2110129Medicaid
KY78011053Medicaid
OH2110129Medicaid