Provider Demographics
NPI:1235403551
Name:LEWIS, DIANA RUSSELL
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:RUSSELL
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 1:4422 GENERAL MEYER AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-3588
Mailing Address - Country:US
Mailing Address - Phone:504-361-6165
Mailing Address - Fax:504-361-6250
Practice Address - Street 1:4422 GENERAL MEYER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-3588
Practice Address - Country:US
Practice Address - Phone:504-361-6165
Practice Address - Fax:504-361-6250
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker