Basic Information
| Provider Information | |||||||||
| NPI: | 1922240753 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | SHEILA | ||||||||
| MiddleName: | JANE | ||||||||
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| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 17050 BAXTER RD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | CHESTERFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630051422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6365370122 | ||||||||
| FaxNumber: | 6365370122 | ||||||||
| Practice Location | |||||||||
| Address1: | 17050 BAXTER RD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | CHESTERFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630051422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6365370122 | ||||||||
| FaxNumber: | 6365370122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2009 | ||||||||
| LastUpdateDate: | 07/11/2014 | ||||||||
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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 | 163WA2000X | 2003020113 | MO | Y | Nursing Service Providers | Registered Nurse | Administrator | 163WP2201X | 2003020113 | MO | N | Nursing Service Providers | Registered Nurse | Ambulatory Care |
No ID Information.