Provider Demographics
NPI:1699856146
Name:HENRY LEWANDOWSKI, PATRICIA (RD, LD, CDE)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:HENRY LEWANDOWSKI
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6875 FM 1488 RD
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-4520
Mailing Address - Country:US
Mailing Address - Phone:281-259-9943
Mailing Address - Fax:281-259-9142
Practice Address - Street 1:6875 FM 1488 RD
Practice Address - Street 2:SUITE 1400
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-4520
Practice Address - Country:US
Practice Address - Phone:281-259-9943
Practice Address - Fax:281-259-9142
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT00285133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00J21AOtherMEDICARE GROUP NUMBER
TX094010801OtherMEDICAID GROUP NUMBER