Provider Demographics
NPI:1982154761
Name:LEWIS, YANIQUE K (RN)
Entity Type:Individual
Prefix:
First Name:YANIQUE
Middle Name:K
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 ROANOKE AVE
Mailing Address - Street 2:APT 5E
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2000
Mailing Address - Country:US
Mailing Address - Phone:631-255-6566
Mailing Address - Fax:
Practice Address - Street 1:1355 ROANOKE AVE
Practice Address - Street 2:APT 5E
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2000
Practice Address - Country:US
Practice Address - Phone:631-255-6566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY720298163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse