Provider Demographics
NPI:1073233698
Name:LEWIS, CARRIE L (CNA)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:L
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13102 HOYNE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-4857
Mailing Address - Country:US
Mailing Address - Phone:601-641-1845
Mailing Address - Fax:
Practice Address - Street 1:13102 HOYNE AVE APT 2
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-4857
Practice Address - Country:US
Practice Address - Phone:601-641-1845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide