Provider Demographics
NPI:1750787826
Name:LEWIS, DEBORAH (MS, RDN, LDN)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2599 KNEFF CEMETERY LN
Mailing Address - Street 2:
Mailing Address - City:CLAY CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62824-2232
Mailing Address - Country:US
Mailing Address - Phone:618-322-4545
Mailing Address - Fax:
Practice Address - Street 1:2599 KNEFF CEMETERY LN
Practice Address - Street 2:
Practice Address - City:CLAY CITY
Practice Address - State:IL
Practice Address - Zip Code:62824-2232
Practice Address - Country:US
Practice Address - Phone:618-322-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164002036133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered