Individual
ROOSEVELT LEWIS III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1208 VFW PKWY STE 301, BOSTON, MA 02132-4344
(617) 401-7441
(617) 203-6651
Mailing address
1208 VFW PKWY STE 301, BOSTON, MA 02132-4344
(617) 401-7441
(617) 203-6651
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN2313246
MA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN2313246
MA
Other
Enumeration date
09/05/2017
Last updated
01/05/2021
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