Provider Demographics
NPI:1891957338
Name:LEWIS, LIONEL J
Entity Type:Individual
Prefix:MR
First Name:LIONEL
Middle Name:J
Last Name:LEWIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21491 SEATON AVE
Mailing Address - Street 2:
Mailing Address - City:PT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33954-3251
Mailing Address - Country:US
Mailing Address - Phone:941-624-6430
Mailing Address - Fax:
Practice Address - Street 1:21491 SEATON AVE
Practice Address - Street 2:
Practice Address - City:PT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33954-3251
Practice Address - Country:US
Practice Address - Phone:941-624-6430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist