Provider Demographics
NPI:1740630284
Name:LEWIS, WANEL N
Entity type:Individual
Prefix:
First Name:WANEL
Middle Name:N
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 1:1106 MACARTHUR DR
Mailing Address - Street 2:STE 6
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3122
Mailing Address - Country:US
Mailing Address - Phone:318-441-2229
Mailing Address - Fax:318-442-2755
Practice Address - Street 1:1106 MACARTHUR DR
Practice Address - Street 2:STE 6
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3122
Practice Address - Country:US
Practice Address - Phone:318-441-2229
Practice Address - Fax:318-442-2755
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15523172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker