Basic Information
| Provider Information | |||||||||
| NPI: | 1619587904 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | WHNP | ||||||||
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| OtherLastName: | LEWIS | ||||||||
| OtherFirstName: | NICOLE | ||||||||
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| OtherCredential: | WHNP | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7535 CARPENTER FIRE STATION RD | ||||||||
| Address2: | STE 105 | ||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275198969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192302100 | ||||||||
| FaxNumber: | 9192302133 | ||||||||
| Practice Location | |||||||||
| Address1: | 4551 NEW BERN AVE STE 160 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276101552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195561008 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2020 | ||||||||
| LastUpdateDate: | 06/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | 5013379 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.