Provider Demographics
NPI:1881239010
Name:LEWIS, PAMELA LARICE (LVN)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:LARICE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 MALAKOFF ST
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76541-8959
Mailing Address - Country:US
Mailing Address - Phone:254-338-1317
Mailing Address - Fax:
Practice Address - Street 1:2200 MALAKOFF ST
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-8959
Practice Address - Country:US
Practice Address - Phone:254-338-1317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX141419164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse