Basic Information
| Provider Information | |||||||||
| NPI: | 1427438001 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | MAGGIE | ||||||||
| MiddleName: | DOTY | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1155 W JEFFERSON ST | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | FRANKLIN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461312730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173463883 | ||||||||
| FaxNumber: | 3173463141 | ||||||||
| Practice Location | |||||||||
| Address1: | 1155 W JEFFERSON ST | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | FRANKLIN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461312730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173463883 | ||||||||
| FaxNumber: | 3173463141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2015 | ||||||||
| LastUpdateDate: | 05/11/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 10001836A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.