Basic Information
| Provider Information | |||||||||
| NPI: | 1992094775 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 255 LOWER CRENSHAW DR | ||||||||
| Address2: | |||||||||
| City: | WETUMPKA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 360928258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3343285281 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2301 HOLMES | ||||||||
| Address2: | TMC-HOSPITAL HILL | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641082792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164044175 | ||||||||
| FaxNumber: | 8164040003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2011 | ||||||||
| LastUpdateDate: | 11/02/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD.33385 | AL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.