Healthcare Provider Details

I. General information

NPI: 1770207474
Provider Name (Legal Business Name): JULIE ANN LEWIS CFM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2022
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3518 RYAN ST
LAKE CHARLES LA
70605-1608
US

IV. Provider business mailing address

1488 TEXAS EASTERN RD
RAGLEY LA
70657-7005
US

V. Phone/Fax

Practice location:
  • Phone: 337-761-5525
  • Fax: 972-982-7066
Mailing address:
  • Phone: 337-842-3837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number001470-2026.0106
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License NumberC54176
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: