Basic Information
| Provider Information | |||||||||
| NPI: | 1871963330 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | SUSAN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | RITTMAN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442701900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309253857 | ||||||||
| FaxNumber: | 3309254016 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | RITTMAN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442701900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309253857 | ||||||||
| FaxNumber: | 3309254016 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2015 | ||||||||
| LastUpdateDate: | 12/14/2016 | ||||||||
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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 | 371204 | OH | N | Nursing Service Providers | Registered Nurse | 363LF0000X | F09151402 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.