Provider Demographics
NPI:1710791868
Name:LEWIS, BERNELL ANTOINETTE
Entity type:Individual
Prefix:
First Name:BERNELL
Middle Name:ANTOINETTE
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 1:51 E SEYMOUR ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-5901
Mailing Address - Country:US
Mailing Address - Phone:215-594-6846
Mailing Address - Fax:
Practice Address - Street 1:51 E SEYMOUR ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-5901
Practice Address - Country:US
Practice Address - Phone:215-594-6846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN322008164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse