Provider Demographics
NPI:1942316021
Name:LEWIS, VICKIE (RN)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-3318
Mailing Address - Country:US
Mailing Address - Phone:903-577-0355
Mailing Address - Fax:903-577-0357
Practice Address - Street 1:508 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-3318
Practice Address - Country:US
Practice Address - Phone:903-577-0355
Practice Address - Fax:903-577-0357
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX688970163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator