Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1033874557 |
---|---|
Provider Name | Ms. Aliyah Gabrielle Lewis |
First Address | Lansing, MI 48910-2889 |
Second Address | Lansing, MI 48910-2889 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2021 |
Last Update Date | 01/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200048271729 | (05) | MI |