Provider Demographics
NPI:1194798710
Name:LEWIS, RENEE LYNN (PAC)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:LYNN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 FRANTZ RD
Mailing Address - Street 2:STE 250
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-6102
Mailing Address - Country:US
Mailing Address - Phone:614-544-6155
Mailing Address - Fax:
Practice Address - Street 1:7450 HOSPITAL DR
Practice Address - Street 2:SUITE 300
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-9642
Practice Address - Country:US
Practice Address - Phone:614-544-8104
Practice Address - Fax:614-533-0128
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50002168363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA23541Medicare PIN
OHQ25026Medicare UPIN