Provider Demographics
NPI:1891981049
Name:LEWIS, LAUREL A N (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LAUREL
Middle Name:A N
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 474
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:NY
Mailing Address - Zip Code:14592-0474
Mailing Address - Country:US
Mailing Address - Phone:585-243-1879
Mailing Address - Fax:
Practice Address - Street 1:2717 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:NY
Practice Address - Zip Code:14592-0474
Practice Address - Country:US
Practice Address - Phone:585-243-1879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101733164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01917344OtherPROVIDER ID NUMBER