Provider Demographics
NPI:1508452798
Name:LEWIS, TAMEKIA F (CN)
Entity Type:Individual
Prefix:
First Name:TAMEKIA
Middle Name:F
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 BURNSIDE TER SE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-8936
Mailing Address - Country:US
Mailing Address - Phone:571-919-8711
Mailing Address - Fax:
Practice Address - Street 1:644 BURNSIDE TER SE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-8936
Practice Address - Country:US
Practice Address - Phone:571-919-8711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-12
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1185915133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist