Provider Demographics
NPI:1629414693
Name:LEWIS, RHONDA J (DOM, LAC, MSOM)
Entity Type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:J
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DOM, LAC, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 FRONT ST # 130
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-3633
Mailing Address - Country:US
Mailing Address - Phone:307-724-6537
Mailing Address - Fax:
Practice Address - Street 1:905 MAIN ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-3440
Practice Address - Country:US
Practice Address - Phone:307-724-6537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1090171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist