Provider Demographics
NPI:1225553464
Name:LEWIS, COURTNEY (RD, RDN)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RD, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-6737
Mailing Address - Country:US
Mailing Address - Phone:315-785-7009
Mailing Address - Fax:315-785-7566
Practice Address - Street 1:727 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-6737
Practice Address - Country:US
Practice Address - Phone:315-785-7009
Practice Address - Fax:315-785-7566
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009035133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist