Individual
MARY JANE LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1370 W D ST, N WILKESBORO, NC 28659-3506
(336) 651-8100
Mailing address
126 JOE OWENS RD, FLEETWOOD, NC 28626-9663
(336) 877-5799
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
172991
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8051430
—
NC
Enumeration date
06/08/2005
Last updated
08/31/2007
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