Provider Demographics
NPI:1760829931
Name:WEST LEWIS, LESHANDRA ROMEL (NA)
Entity Type:Individual
Prefix:MRS
First Name:LESHANDRA
Middle Name:ROMEL
Last Name:WEST LEWIS
Suffix:
Gender:F
Credentials:NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 MARYLAND DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39209-3343
Mailing Address - Country:US
Mailing Address - Phone:404-719-0882
Mailing Address - Fax:
Practice Address - Street 1:326 MARYLAND DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39209-3343
Practice Address - Country:US
Practice Address - Phone:404-719-0882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health