Basic Information
| Provider Information | |||||||||
| NPI: | 1093448854 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | MAUREEN | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 159 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA CROSS ROADS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 169140159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037525510 | ||||||||
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| Practice Location | |||||||||
| Address1: | 45 MUD CREEK RD | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 169479529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702973746 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2022 | ||||||||
| LastUpdateDate: | 09/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | SP026022 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 163W00000X | RN694325 | PA | N | Nursing Service Providers | Registered Nurse |
No ID Information.