Provider Demographics
NPI:1083289292
Name:LEWIS, GABRIELLE LEIGH
Entity Type:Individual
Prefix:MS
First Name:GABRIELLE
Middle Name:LEIGH
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 1:4402 OHIO ST NE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-5716
Mailing Address - Country:US
Mailing Address - Phone:540-529-6223
Mailing Address - Fax:
Practice Address - Street 1:4402 OHIO ST NE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-5716
Practice Address - Country:US
Practice Address - Phone:540-529-6223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program