Provider Demographics
NPI:1700886611
Name:LEWIS, MICHELE THERESE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:THERESE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CRNA
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 890235
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-0235
Mailing Address - Country:US
Mailing Address - Phone:800-919-1190
Mailing Address - Fax:800-919-1190
Practice Address - Street 1:607 BEAMAN ST
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2603
Practice Address - Country:US
Practice Address - Phone:910-592-8511
Practice Address - Fax:910-592-8511
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC121721367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8051683Medicaid
NCD3601OtherMEDCOST
NC2617817BMedicare PIN