Provider Demographics
NPI:1548521180
Name:LEWIS, PENELEPE (NP)
Entity type:Individual
Prefix:
First Name:PENELEPE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 W PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4427
Mailing Address - Country:US
Mailing Address - Phone:843-669-1010
Mailing Address - Fax:843-669-7676
Practice Address - Street 1:507 W PALMETTO ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4427
Practice Address - Country:US
Practice Address - Phone:843-669-1010
Practice Address - Fax:843-669-7676
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3295363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner