Healthcare Provider Details

I. General information

NPI: 1801659354
Provider Name (Legal Business Name): LERON THOMAS LEWIS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 UNIVERSITY DR
VIRGINIA BEACH VA
23453-8083
US

IV. Provider business mailing address

8 WINSTON AVE
NEWPORT NEWS VA
23601-2123
US

V. Phone/Fax

Practice location:
  • Phone: 757-683-4297
  • Fax:
Mailing address:
  • Phone: 540-538-2274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number0001317326
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: