Provider Demographics
NPI:1114009610
Name:LEWIS, RUTHIE L (LPN)
Entity Type:Individual
Prefix:
First Name:RUTHIE
Middle Name:L
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423A BEULAH AVENUE
Mailing Address - Street 2:
Mailing Address - City:TYLERTOWN
Mailing Address - State:MS
Mailing Address - Zip Code:39667
Mailing Address - Country:US
Mailing Address - Phone:601-876-6169
Mailing Address - Fax:601-876-6120
Practice Address - Street 1:423A BEULAH AVENUE
Practice Address - Street 2:
Practice Address - City:TYLERTOWN
Practice Address - State:MS
Practice Address - Zip Code:39667
Practice Address - Country:US
Practice Address - Phone:601-876-6169
Practice Address - Fax:601-876-6120
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP278719164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse