Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1219 | NH |
NPI | 1205029782 |
---|---|
Provider Name | Ms. Katrina M Lewis |
First Address | Lebanon, NH 03756-1000 |
Second Address | Lebanon, NH 03756-1000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2007 |
Last Update Date | 20/08/2007 |