Provider Demographics
NPI:1386718369
Name:LEWIS, V IRGINIA ANN (LPN)
Entity type:Individual
Prefix:
First Name:V IRGINIA
Middle Name:ANN
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 1:7893 ONEIDA TRL
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:13030-8403
Mailing Address - Country:US
Mailing Address - Phone:315-380-6774
Mailing Address - Fax:
Practice Address - Street 1:7893 ONEIDA TRL
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:NY
Practice Address - Zip Code:13030-8403
Practice Address - Country:US
Practice Address - Phone:315-380-6774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167974-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01977100Medicaid