Provider Demographics
NPI:1396789517
Name:LEWIS, MARY BETH HOPPE (NP)
Entity type:Individual
Prefix:MISS
First Name:MARY BETH
Middle Name:HOPPE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:MARYBETH
Other - Middle Name:HOPPE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:WHNP
Mailing Address - Street 1:51 BUFFALO CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:ELMA
Mailing Address - State:NY
Mailing Address - Zip Code:14059
Mailing Address - Country:US
Mailing Address - Phone:716-805-0069
Mailing Address - Fax:716-639-0875
Practice Address - Street 1:1150 YOUNGS RD
Practice Address - Street 2:107
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-8053
Practice Address - Country:US
Practice Address - Phone:716-636-9112
Practice Address - Fax:716-639-0875
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420496-1363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9512294OtherINDEPENDENT HEALTH
NY01993728Medicaid
NY040426000612OtherFIDELIUS
NY000560469002OtherCOMMUNITY BLUE/BLUE CROSS
NY050819000018OtherFIDELIS CARE
NY000560469002OtherCOMMUNITY BLUE/BLUE CROSS