Healthcare Provider Details

I. General information

NPI: 1114748423
Provider Name (Legal Business Name): CEREESE N LEWIS SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CEREESE LEWIS SMITH MHA, MSN, RN

II. Dates (important events)

Enumeration Date: 10/19/2024
Last Update Date: 10/19/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 304867
ST.THOMAS VIRGIN ISLANDS
00803
UM

IV. Provider business mailing address

PO BOX 304867
ST.THOMAS VIRGIN ISLANDS
00803
UM

V. Phone/Fax

Practice location:
  • Phone: 340-642-6773
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number6065
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: