Provider Demographics
NPI:1891027165
Name:LEWIS, WENDY L (RN)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:L
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 1:978 TOWNSHIP ROAD 350
Mailing Address - Street 2:
Mailing Address - City:NOVA
Mailing Address - State:OH
Mailing Address - Zip Code:44859-9706
Mailing Address - Country:US
Mailing Address - Phone:419-913-5076
Mailing Address - Fax:
Practice Address - Street 1:978 TOWNSHIP ROAD 350
Practice Address - Street 2:
Practice Address - City:NOVA
Practice Address - State:OH
Practice Address - Zip Code:44859-9706
Practice Address - Country:US
Practice Address - Phone:419-913-5076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH RN276786163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse