Healthcare Provider Details

I. General information

NPI: 1003896358
Provider Name (Legal Business Name): ANGELIA DENIESE LEWIS A.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 N BAYOU ST
MOBILE AL
36603
US

IV. Provider business mailing address

PO BOX 2867
MOBILE AL
36652-2867
US

V. Phone/Fax

Practice location:
  • Phone: 251-690-8894
  • Fax: 251-544-2188
Mailing address:
  • Phone: 251-690-8894
  • Fax: 251-544-2188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9232731
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-073404
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: