Provider Demographics
NPI:1215065966
Name:LEWIS, MARY THERESA (LPN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:THERESA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 LEETOWN RD
Mailing Address - Street 2:
Mailing Address - City:STORMVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12582-5616
Mailing Address - Country:US
Mailing Address - Phone:845-223-8469
Mailing Address - Fax:
Practice Address - Street 1:44 SPRINGWOOD DR
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572
Practice Address - Country:US
Practice Address - Phone:845-876-5628
Practice Address - Fax:845-876-7665
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY132323-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse