Provider Demographics
NPI:1427392224
Name:LEWIS, DESIREE A
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:A
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 1:990 E CALVADA
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-5603
Mailing Address - Country:US
Mailing Address - Phone:775-751-5211
Mailing Address - Fax:775-751-6176
Practice Address - Street 1:990 E CALVADA
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-5603
Practice Address - Country:US
Practice Address - Phone:775-751-5211
Practice Address - Fax:775-751-6176
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor