Provider Demographics
NPI:1972887511
Name:LEWIS, ELLEN MINA (ND)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:MINA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:ND
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 4065
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-4065
Mailing Address - Country:US
Mailing Address - Phone:203-916-4600
Mailing Address - Fax:203-916-4601
Practice Address - Street 1:260 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4804
Practice Address - Country:US
Practice Address - Phone:203-916-4600
Practice Address - Fax:203-416-9601
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2014-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1838175F00000X
CT000493175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath