Provider Demographics
NPI:1760834014
Name:LEWIS, MARLENA DELICE
Entity Type:Individual
Prefix:
First Name:MARLENA
Middle Name:DELICE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21530 DEQUINDRE RD APT 204
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-2260
Mailing Address - Country:US
Mailing Address - Phone:313-686-4226
Mailing Address - Fax:
Practice Address - Street 1:21530 DEQUINDRE RD APT 204
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-2260
Practice Address - Country:US
Practice Address - Phone:313-686-4226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other