Provider Demographics
NPI:1023552700
Name:LEWIS, LATONYA L
Entity Type:Individual
Prefix:
First Name:LATONYA
Middle Name:L
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:L
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3324 S BRYANT AVE
Mailing Address - Street 2:APT 134
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-1705
Mailing Address - Country:US
Mailing Address - Phone:405-488-5980
Mailing Address - Fax:
Practice Address - Street 1:3324 S BRYANT AVE
Practice Address - Street 2:APT134
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-1705
Practice Address - Country:US
Practice Address - Phone:405-488-5980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKP999031615175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist