Provider Demographics
NPI:1205235678
Name:LEWIS, MICHELLE MIHONET I (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MIHONET
Last Name:LEWIS
Suffix:I
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PARKVIEW PL
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4818
Mailing Address - Country:US
Mailing Address - Phone:917-796-1546
Mailing Address - Fax:
Practice Address - Street 1:100E 77TH ST
Practice Address - Street 2:
Practice Address - City:NY, NY
Practice Address - State:NY
Practice Address - Zip Code:10065
Practice Address - Country:US
Practice Address - Phone:212-434-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306419-1282N00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No282N00000XHospitalsGeneral Acute Care Hospital