Provider Demographics
NPI:1831364819
Name:LEWIS, BETTY DELORES (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:DELORES
Last Name:LEWIS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 N 32ND ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-7506
Mailing Address - Country:US
Mailing Address - Phone:804-222-7982
Mailing Address - Fax:
Practice Address - Street 1:618 N 32ND ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-7506
Practice Address - Country:US
Practice Address - Phone:804-222-7982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001062303163W00000X, 163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005002079OtherPROVIDER NUMBER