Healthcare Provider Details

I. General information

NPI: 1376452557
Provider Name (Legal Business Name): VIVIAN ROLANDA LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

BUILDING 4-2843 NORMANDY DRIVE
FORT BRAGG NC
28310-0001
US

IV. Provider business mailing address

BUILDING 4-2843 NORMANDY DRIVE
FORT BRAGG NC
28310-0001
US

V. Phone/Fax

Practice location:
  • Phone: 910-907-4753
  • Fax:
Mailing address:
  • Phone: 910-907-4753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: