Provider Demographics
NPI:1508201500
Name:LEWIS, LISA MARIE
Entity Type:Individual
Prefix:MISS
First Name:LISA
Middle Name:MARIE
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 1:128 S PETERS AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6034
Mailing Address - Country:US
Mailing Address - Phone:405-701-8163
Mailing Address - Fax:405-310-3739
Practice Address - Street 1:128 S PETERS AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6034
Practice Address - Country:US
Practice Address - Phone:405-701-8163
Practice Address - Fax:405-310-3739
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency