Provider Demographics
NPI:1730318841
Name:LEWIS, ANGELA R (LPN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:R
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1696 W MAIN CIR APT 18
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-6841
Mailing Address - Country:US
Mailing Address - Phone:920-676-4543
Mailing Address - Fax:
Practice Address - Street 1:1696 W MAIN CIR APT 18
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-6841
Practice Address - Country:US
Practice Address - Phone:920-676-4543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI311320-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse