Provider Demographics
NPI:1558697979
Name:LEWIS, ANGELA L (STNA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:L
Last Name:LEWIS
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-2428
Mailing Address - Country:US
Mailing Address - Phone:937-418-9922
Mailing Address - Fax:
Practice Address - Street 1:508 HARRISON ST
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-2428
Practice Address - Country:US
Practice Address - Phone:937-418-9922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400101490402376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH400101490402OtherSTNA