Healthcare Provider Details

I. General information

NPI: 1295654127
Provider Name (Legal Business Name): LAURA PEREZ LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 E 5TH ST
FREMONT NE
68025-5202
US

IV. Provider business mailing address

1120 E 5TH ST
FREMONT NE
68025-5202
US

V. Phone/Fax

Practice location:
  • Phone: 712-310-1953
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberH13314780
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: