Individual
MARY E. LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
122 12TH ST, PRINCETON, WV 24740-2312
(304) 431-5536
(304) 487-7743
Mailing address
122 12TH ST, PRINCETON, WV 24740-2312
(304) 431-5536
(304) 487-7743
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
73538
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
WV4776A
PALMETTO GBA- PTAN
WV
Enumeration date
08/15/2014
Last updated
10/31/2024
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