Healthcare Provider Details

I. General information

NPI: 1821639709
Provider Name (Legal Business Name): TONIA SUE LEWIS PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 BRIERTON LN
FESTUS MO
63028-1972
US

IV. Provider business mailing address

8746 LITTLE DEER DR
DITTMER MO
63023-3606
US

V. Phone/Fax

Practice location:
  • Phone: 636-931-0300
  • Fax:
Mailing address:
  • Phone: 636-428-9510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2019037058
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number2019037058
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: