Provider Demographics
NPI:1629626056
Name:LEWIS, MEGAN (RD, LD, RN)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RD, LD, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 W MAPLE ST STE 105
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-2858
Mailing Address - Country:US
Mailing Address - Phone:419-348-4757
Mailing Address - Fax:
Practice Address - Street 1:1303 W MAPLE ST STE 105
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-2858
Practice Address - Country:US
Practice Address - Phone:419-348-4757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD6578133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty