Provider Demographics
NPI:1811567340
Name:LEWIS, CHANTAL A
Entity Type:Individual
Prefix:
First Name:CHANTAL
Middle Name:A
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 1:25963 NORFOLK ST
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-2431
Mailing Address - Country:US
Mailing Address - Phone:734-635-0465
Mailing Address - Fax:
Practice Address - Street 1:958 N NEWBURGH RD STE 7
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-3286
Practice Address - Country:US
Practice Address - Phone:734-635-0465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide