Provider Demographics
NPI:1619486537
Name:LEWIS-MOUTON, DIANN
Entity Type:Individual
Prefix:
First Name:DIANN
Middle Name:
Last Name:LEWIS-MOUTON
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 1:12580 PIPING ROCK DR APT 1
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-5858
Mailing Address - Country:US
Mailing Address - Phone:832-329-9189
Mailing Address - Fax:
Practice Address - Street 1:12580 PIPING ROCK DR APT 1
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-5858
Practice Address - Country:US
Practice Address - Phone:832-329-9189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health