Provider Demographics
NPI:1649041021
Name:JUAH, LEWIS J
Entity type:Individual
Prefix:
First Name:LEWIS
Middle Name:J
Last Name:JUAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 PUTTER ST
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:DE
Mailing Address - Zip Code:19734-2851
Mailing Address - Country:US
Mailing Address - Phone:267-974-5703
Mailing Address - Fax:
Practice Address - Street 1:322 PUTTER ST # DE
Practice Address - Street 2:
Practice Address - City:TOWNSEND
Practice Address - State:DE
Practice Address - Zip Code:19734-2851
Practice Address - Country:US
Practice Address - Phone:267-974-5703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2023896435374K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner