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Individual

MARY B. LEWIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
N.P.

Contact information

Practice address
3400 E MARKET ST, LOGANSPORT, IN 46947-2295
(574) 722-9633
(574) 722-5987
Mailing address
3400 E MARKET ST, LOGANSPORT, IN 46947-2295
(574) 722-9633
(574) 722-5987

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71000994A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000550574
ANTHEM BLUE CROSS
IN
05
200932700
IN
01
P00626250
RAILROAD MEDICARE
IN
Enumeration date
09/21/2007
Last updated
10/28/2011
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