Provider Demographics
NPI:1457809907
Name:LEWIS, SARA (CSFA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 W ROUND BUNCH RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77611-2428
Mailing Address - Country:US
Mailing Address - Phone:409-892-3707
Mailing Address - Fax:409-892-4185
Practice Address - Street 1:820 W ROUND BUNCH RD
Practice Address - Street 2:
Practice Address - City:BRIDGE CITY
Practice Address - State:TX
Practice Address - Zip Code:77611
Practice Address - Country:US
Practice Address - Phone:409-892-3707
Practice Address - Fax:409-892-4185
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty