Provider Demographics
NPI:1770207474
Name:LEWIS, JULIE ANN (CFM)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1488 TEXAS EASTERN RD
Mailing Address - Street 2:
Mailing Address - City:RAGLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70657-7005
Mailing Address - Country:US
Mailing Address - Phone:337-842-3837
Mailing Address - Fax:
Practice Address - Street 1:340 N HIGHWAY 171
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70611-5345
Practice Address - Country:US
Practice Address - Phone:337-842-3837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC54176224900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter