Provider Demographics
NPI:1841755782
Name:LEWIS, JEWELL D
Entity Type:Individual
Prefix:
First Name:JEWELL
Middle Name:D
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 1:445 SW DALTON CIR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-5851
Mailing Address - Country:US
Mailing Address - Phone:772-224-2510
Mailing Address - Fax:772-323-0174
Practice Address - Street 1:445 SW DALTON CIR
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-5851
Practice Address - Country:US
Practice Address - Phone:772-224-2510
Practice Address - Fax:772-323-0174
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906913163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator