Provider Demographics
NPI:1619553740
Name:LEWIS, PATSY NELL
Entity type:Individual
Prefix:
First Name:PATSY
Middle Name:NELL
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 VICTORY DR
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-1250
Mailing Address - Country:US
Mailing Address - Phone:203-397-5255
Mailing Address - Fax:203-691-7496
Practice Address - Street 1:24 VICTORY DR
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-1250
Practice Address - Country:US
Practice Address - Phone:203-397-5255
Practice Address - Fax:203-691-7496
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTHCA.0001260251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health