Provider Demographics
NPI:1306020573
Name:LEWIS, SHARON DENISE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:DENISE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:303 B STREET
Mailing Address - Street 2:
Mailing Address - City:MERTIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301
Mailing Address - Country:US
Mailing Address - Phone:601-880-3120
Mailing Address - Fax:601-482-5061
Practice Address - Street 1:303 B STREET
Practice Address - Street 2:
Practice Address - City:MERTIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301
Practice Address - Country:US
Practice Address - Phone:601-880-3120
Practice Address - Fax:601-482-5061
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP142948164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse