Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP09235 | LA |
NPI | 1003356627 |
---|---|
Provider Name | Christian Lewis |
First Address | Jennings, LA 70546-4100 |
Second Address | Jennings, LA 70546-4100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2017 |
Last Update Date | 01/03/2017 |