Basic Information
| Provider Information | |||||||||
| NPI: | 1578970695 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWELLEN | ||||||||
| FirstName: | DONNA | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41817B LOOP RD | ||||||||
| Address2: | |||||||||
| City: | NORWOOD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281287767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102209300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 284 EXECUTIVE PARK DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280251831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049391100 | ||||||||
| FaxNumber: | 7049391173 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2014 | ||||||||
| LastUpdateDate: | 07/21/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 64628 | NC | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.