Provider Demographics
NPI:1871849380
Name:LEWIS, PRINCESS LEE
Entity Type:Individual
Prefix:
First Name:PRINCESS
Middle Name:LEE
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 1:30 N MEADOWCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-1718
Mailing Address - Country:US
Mailing Address - Phone:501-442-9061
Mailing Address - Fax:
Practice Address - Street 1:30 N MEADOWCLIFF DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-1718
Practice Address - Country:US
Practice Address - Phone:501-442-9061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARN/AOtherDDS/ DHHS