Provider Demographics
NPI:1720742158
Name:LEWIS, MONICA DENISE (FNP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:DENISE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 BIG BAY RD
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:SC
Mailing Address - Zip Code:29510-5361
Mailing Address - Country:US
Mailing Address - Phone:843-325-9783
Mailing Address - Fax:
Practice Address - Street 1:1423 WINYAH ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-4730
Practice Address - Country:US
Practice Address - Phone:843-546-6081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF04210486363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCF04210486OtherFNP CERTIFICATION
SCF04210486OtherFNP