Provider Demographics
NPI:1912873597
Name:LEWIS, DOMINIQUE CHARESE
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:CHARESE
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 1:707 CARVER
Mailing Address - Street 2:
Mailing Address - City:HUGHES SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75656-3627
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:707 CARVER
Practice Address - Street 2:
Practice Address - City:HUGHES SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75656-3627
Practice Address - Country:US
Practice Address - Phone:903-424-7391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX805084163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse