Provider Demographics
NPI:1861009185
Name:LEWIS, MIESHA NICOLE (MT)
Entity Type:Individual
Prefix:
First Name:MIESHA
Middle Name:NICOLE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3759 THOMAS AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-1840
Mailing Address - Country:US
Mailing Address - Phone:763-273-7341
Mailing Address - Fax:
Practice Address - Street 1:3759 THOMAS AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55412-1840
Practice Address - Country:US
Practice Address - Phone:763-274-7341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist