Healthcare Provider Details

I. General information

NPI: 1063447332
Provider Name (Legal Business Name): ANDREA L. LEWIS MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E BROADWAY 4TH FLOOR
LOUISVILLE KY
40202-1703
US

IV. Provider business mailing address

315 E BROADWAY 4TH FLOOR
LOUISVILLE KY
40202-1703
US

V. Phone/Fax

Practice location:
  • Phone: 502-629-4108
  • Fax: 502-629-3166
Mailing address:
  • Phone: 502-629-4108
  • Fax: 502-629-3166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: