Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 2063-M | AR |
NPI | 1003073305 |
---|---|
Provider Name | Iva N Lewis |
First Address | Jonesboro, AR 72401-7213 |
Second Address | Jonesboro, AR 72401-7213 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2008 |
Last Update Date | 22/05/2008 |