Provider Demographics
NPI:1710040415
Name:LEWIS, LISA VIRGINIA (CHHA)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:VIRGINIA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CHHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38150 LEWIS ROAD
Mailing Address - Street 2:
Mailing Address - City:POMEROY
Mailing Address - State:OH
Mailing Address - Zip Code:45769
Mailing Address - Country:US
Mailing Address - Phone:740-742-3180
Mailing Address - Fax:
Practice Address - Street 1:38150 LEWIS ROAD
Practice Address - Street 2:
Practice Address - City:POMEROY
Practice Address - State:OH
Practice Address - Zip Code:45769
Practice Address - Country:US
Practice Address - Phone:740-742-3180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171W00000X171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2141387Medicare ID - Type Unspecified