Provider Demographics
NPI:1083857189
Name:LEWIS, JEANNE ANN (IDMT)
Entity Type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:ANN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 ARNOLD ST
Mailing Address - Street 2:BLDG 5801
Mailing Address - City:TINKER AFB
Mailing Address - State:OK
Mailing Address - Zip Code:73145-8105
Mailing Address - Country:US
Mailing Address - Phone:405-736-4500
Mailing Address - Fax:405-736-2677
Practice Address - Street 1:5700 ARNOLD ST
Practice Address - Street 2:BLDG 5801
Practice Address - City:TINKER AFB
Practice Address - State:OK
Practice Address - Zip Code:73145-8105
Practice Address - Country:US
Practice Address - Phone:405-736-4500
Practice Address - Fax:405-736-2677
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians