Provider Demographics
NPI:1245781509
Name:LEWIS, LAURA LIESELOTTE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LIESELOTTE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:9601 DEMONA CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78733-1681
Mailing Address - Country:US
Mailing Address - Phone:512-423-1732
Mailing Address - Fax:512-328-7690
Practice Address - Street 1:555 CREEKSIDE XING
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-2594
Practice Address - Country:US
Practice Address - Phone:210-771-6181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109951363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant