Provider Demographics
NPI:1558911016
Name:LEWIS, VALERIE MICHELLE
Entity Type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:MICHELLE
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 1:12514 MOCCASIN GAP ROAD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309
Mailing Address - Country:US
Mailing Address - Phone:850-893-1480
Mailing Address - Fax:
Practice Address - Street 1:12514 MOCCASIN GAP ROAD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309
Practice Address - Country:US
Practice Address - Phone:850-893-1480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider