Provider Demographics
NPI:1114541067
Name:LEWIS, WENDY (LPN)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
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 1:940 C HWY 96
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31099
Mailing Address - Country:US
Mailing Address - Phone:478-988-7100
Mailing Address - Fax:478-988-6847
Practice Address - Street 1:940 GA HIGHWAY 96 STE C
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-2585
Practice Address - Country:US
Practice Address - Phone:478-988-7100
Practice Address - Fax:478-988-6847
Is Sole Proprietor?:No
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN070979164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse