Provider Demographics
NPI:1457717498
Name:LEWIS, ANGELETTE ROCHELLE
Entity Type:Individual
Prefix:MS
First Name:ANGELETTE
Middle Name:ROCHELLE
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 1:6001 SW 12TH ST
Mailing Address - Street 2:APT. #917
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73128-1861
Mailing Address - Country:US
Mailing Address - Phone:405-835-8525
Mailing Address - Fax:
Practice Address - Street 1:6001 SW 12TH ST
Practice Address - Street 2:APT. #917
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73128-1861
Practice Address - Country:US
Practice Address - Phone:405-835-8525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator