Provider Demographics
NPI:1083434351
Name:LEWIS, BEATRICE GWEN (MSN, FNP-BC)
Entity type:Individual
Prefix:
First Name:BEATRICE
Middle Name:GWEN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 W WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44507-1354
Mailing Address - Country:US
Mailing Address - Phone:330-718-7484
Mailing Address - Fax:
Practice Address - Street 1:5701 BURNETT RD
Practice Address - Street 2:
Practice Address - City:LEAVITTSBURG
Practice Address - State:OH
Practice Address - Zip Code:44430-9713
Practice Address - Country:US
Practice Address - Phone:330-898-0820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0036651363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily