Provider Demographics
NPI:1922157114
Name:LEWIS, CHRISTINE NICOLE (RD)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:NICOLE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1177 N KNOTTY PINE LN
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81007-3902
Mailing Address - Country:US
Mailing Address - Phone:719-285-2034
Mailing Address - Fax:719-285-2277
Practice Address - Street 1:1338 PHAY AVE
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-2302
Practice Address - Country:US
Practice Address - Phone:719-285-2034
Practice Address - Fax:719-285-2277
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered