Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 4193 | TX |
NPI | 1528004025 |
---|---|
Provider Name | Dr. Doreen Lewis-Overton |
First Address | San Antonio, TX 78232-5021 |
Second Address | San Antonio, TX 78232-5021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 09/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T14399 | (02) | TX |