Provider Demographics
NPI:1316972011
Name:LEWIS, JEAN H (BSN, APRN-BC)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:H
Last Name:LEWIS
Suffix:
Gender:F
Credentials:BSN, APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5452 GIRARD AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-1649
Mailing Address - Country:US
Mailing Address - Phone:612-824-4663
Mailing Address - Fax:
Practice Address - Street 1:1 VETERANS DR IVE 112D
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2309
Practice Address - Country:US
Practice Address - Phone:612-467-3460
Practice Address - Fax:612-467-2232
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN064844-6363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health