Provider Demographics
NPI:1962477521
Name:FLORES-LEWIS, JANICE (NP)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:FLORES-LEWIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:F
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:5 NEPONSET ST FL STREET12
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-595-2855
Mailing Address - Fax:508-425-5656
Practice Address - Street 1:5 NEPONSET ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-2714
Practice Address - Country:US
Practice Address - Phone:508-595-2855
Practice Address - Fax:508-425-5656
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208839363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
042472266OtherPRIVATE HEALTHCARE SYSTEM
042472266OtherTHREE RIVERS
042472266016OtherTRICARE CHAMPUS
57177OtherFALLON COMM HEALTH PLAN
AA3672OtherHARVARD PILGRIM
NP1125OtherBLUE SHIELD HMO BLUE
4142203OtherMVP HEALTH CARE
500007592OtherRAILROAD MEDICARE
NP1125OtherBLUE CARE ELECT
MA0324574Medicaid
NP1125OtherBLUE SHIELD INDEMNITY
S56527Medicare UPIN
NP1125OtherBLUE SHIELD INDEMNITY