Individual
INGRID LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
12866 FORT ST, SOUTHGATE, MI 48195-1060
(734) 720-7920
(734) 720-7965
Mailing address
20831 RIDGEMONT RD, HARPER WOODS, MI 48225-1137
(313) 930-0258
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704231587
MI
363L00000X
Nurse Practitioner
Primary
4704231587
MI
Other
Enumeration date
05/21/2018
Last updated
08/23/2021
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