Provider Demographics
NPI:1780240242
Name:LEWIS, NIKAMIAH
Entity type:Individual
Prefix:
First Name:NIKAMIAH
Middle Name:
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 1:101 WILLOW CREEK CT APT A
Mailing Address - Street 2:
Mailing Address - City:HALLSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75650-6615
Mailing Address - Country:US
Mailing Address - Phone:907-351-8404
Mailing Address - Fax:
Practice Address - Street 1:101 WILLOW CREEK CT APT A
Practice Address - Street 2:
Practice Address - City:HALLSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75650-6615
Practice Address - Country:US
Practice Address - Phone:907-351-8404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX939043163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse