Provider Demographics
NPI:1740087097
Name:LEWIS, NIKEO NICHELLE (LPN)
Entity type:Individual
Prefix:MRS
First Name:NIKEO
Middle Name:NICHELLE
Last Name:LEWIS
Suffix:
Gender:
Credentials:LPN
Other - Prefix:MS
Other - First Name:NIKEO
Other - Middle Name:NICHELLE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1102 RUSHING AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-2640
Mailing Address - Country:US
Mailing Address - Phone:504-206-7924
Mailing Address - Fax:
Practice Address - Street 1:2322 196TH ST SW STE 100
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-7010
Practice Address - Country:US
Practice Address - Phone:425-672-7293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS336525164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse