Provider Demographics
NPI:1891091187
Name:LEWIS, TAMMY LYNN (RN)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNN
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 1:3074 BELTZ RD
Mailing Address - Street 2:
Mailing Address - City:SARDINIA
Mailing Address - State:OH
Mailing Address - Zip Code:45171-8253
Mailing Address - Country:US
Mailing Address - Phone:937-515-5058
Mailing Address - Fax:
Practice Address - Street 1:3074 BELTZ RD
Practice Address - Street 2:
Practice Address - City:SARDINIA
Practice Address - State:OH
Practice Address - Zip Code:45171-8253
Practice Address - Country:US
Practice Address - Phone:937-515-5058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-03
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH314597163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse