Provider Demographics
NPI:1891079802
Name:LEWIS, AMY SUE (RN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:SUE
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 1:34855 N JAMES AVE
Mailing Address - Street 2:
Mailing Address - City:INGLESIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60041-9574
Mailing Address - Country:US
Mailing Address - Phone:224-406-2755
Mailing Address - Fax:262-577-8399
Practice Address - Street 1:34855 N JAMES AVE
Practice Address - Street 2:
Practice Address - City:INGLESIDE
Practice Address - State:IL
Practice Address - Zip Code:60041-9574
Practice Address - Country:US
Practice Address - Phone:224-406-2755
Practice Address - Fax:262-577-8399
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA085207163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health