Provider Demographics
NPI:1972798213
Name:LEWIS, ELIZABETH S (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:S
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:E
Other - Last Name:STUCKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:101 MEMORIAL HOSPITAL DRIVE, SUITE 100
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608
Mailing Address - Country:US
Mailing Address - Phone:251-343-9090
Mailing Address - Fax:251-380-1015
Practice Address - Street 1:3290 DAUPHIN ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-4062
Practice Address - Country:US
Practice Address - Phone:251-660-5930
Practice Address - Fax:251-660-5931
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1072895363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL172380Medicaid