Provider Demographics
NPI:1801311378
Name:LEWIS, RACHAEL E (CRNP)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:E
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5890 WATERLOO RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2617
Mailing Address - Country:US
Mailing Address - Phone:667-214-2100
Mailing Address - Fax:
Practice Address - Street 1:5890 WATERLOO RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2617
Practice Address - Country:US
Practice Address - Phone:667-214-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9466719363LF0000X
MDR194313363LF0000X
FL9466719363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty