Provider Demographics
NPI:1467112391
Name:LEWIS-BOWEN, RENITA FAYE
Entity Type:Individual
Prefix:
First Name:RENITA
Middle Name:FAYE
Last Name:LEWIS-BOWEN
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 1:2600 E QUEENS ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-6753
Mailing Address - Country:US
Mailing Address - Phone:918-984-5888
Mailing Address - Fax:
Practice Address - Street 1:2508 E 71ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-5572
Practice Address - Country:US
Practice Address - Phone:918-794-6570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist