Basic Information
| Provider Information | |||||||||
| NPI: | 1245225804 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | MARSHA | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1104 N SUNSET | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 67878 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6203845439 | ||||||||
| FaxNumber: | 6202744729 | ||||||||
| Practice Location | |||||||||
| Address1: | 712 SAINT JOHN ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | GARDEN CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 678465128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202751766 | ||||||||
| FaxNumber: | 6202754729 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2005 | ||||||||
| LastUpdateDate: | 07/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 44876 | KS | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 161288 | 01 | KS | BC/BS PROVIDER NUMBER | OTHER |