Healthcare Provider Details

I. General information

NPI: 1194011700
Provider Name (Legal Business Name): JANINE MARIE LEWIS R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 10/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NE SAINT LUKES BLVD
LEES SUMMIT MO
64086-6000
US

IV. Provider business mailing address

901 E 104TH ST
KANSAS CITY MO
64131-4517
US

V. Phone/Fax

Practice location:
  • Phone: 816-347-5197
  • Fax:
Mailing address:
  • Phone: 816-502-8752
  • Fax: 816-932-9670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number133V00000X
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: