Healthcare Provider Details

I. General information

NPI: 1528027620
Provider Name (Legal Business Name): VIRGINIA P LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 10/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 CIRCLE DR
WEST MONROE LA
71291-5308
US

IV. Provider business mailing address

324 CIRCLE DR
WEST MONROE LA
71291-5308
US

V. Phone/Fax

Practice location:
  • Phone: 318-322-3535
  • Fax: 318-322-3560
Mailing address:
  • Phone: 318-322-3535
  • Fax: 318-322-3560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number024992
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: