Basic Information
| Provider Information | |||||||||
| NPI: | 1588819106 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWIN | ||||||||
| FirstName: | WENDI | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | E HWY 18 | ||||||||
| Address2: | POSTOFFICE BOX 1201 | ||||||||
| City: | PINE PIDGE | ||||||||
| State: | SD | ||||||||
| PostalCode: | 57770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6058673068 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | EAST HWY 18 | ||||||||
| Address2: | P0 BOX 1201 | ||||||||
| City: | PINE RIDGE | ||||||||
| State: | SD | ||||||||
| PostalCode: | 57770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6058673068 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2008 | ||||||||
| LastUpdateDate: | 11/24/2008 | ||||||||
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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 | 163W00000X | 49219 | NE | Y | Nursing Service Providers | Registered Nurse |
No ID Information.