Provider Demographics
NPI:1124472295
Name:LEWIS, KRISTIN NICHOLE (RN)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:NICHOLE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:NICHOLE
Other - Last Name:PASCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:9314 DECATUR RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1824
Mailing Address - Country:US
Mailing Address - Phone:989-289-5527
Mailing Address - Fax:
Practice Address - Street 1:2450 BUCKLEY RD
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-3092
Practice Address - Country:US
Practice Address - Phone:224-610-8719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704289708163W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No163W00000XNursing Service ProvidersRegistered Nurse