Provider Demographics
NPI:1104434315
Name:LEWIS, EVENLY (RN BSN OCN WHE)
Entity type:Individual
Prefix:
First Name:EVENLY
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RN BSN OCN WHE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-4748
Mailing Address - Country:US
Mailing Address - Phone:908-220-3323
Mailing Address - Fax:
Practice Address - Street 1:455 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-4748
Practice Address - Country:US
Practice Address - Phone:908-220-3323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator