Provider Demographics
NPI:1780915280
Name:LEWIS, MAXINE ANDREA (REGISTERED NURSE)
Entity type:Individual
Prefix:MS
First Name:MAXINE
Middle Name:ANDREA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 TOWN HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-1162
Mailing Address - Country:US
Mailing Address - Phone:516-244-1683
Mailing Address - Fax:516-308-4131
Practice Address - Street 1:38 TOWN HOUSE DR
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PK
Practice Address - State:NY
Practice Address - Zip Code:11762-1162
Practice Address - Country:US
Practice Address - Phone:516-244-1683
Practice Address - Fax:516-308-4131
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY404470163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse