Healthcare Provider Details

I. General information

NPI: 1770328072
Provider Name (Legal Business Name): IMANI LEWIS-NORELLE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2423 AMERICAN LN STE 5
MADISON WI
53704-3138
US

IV. Provider business mailing address

1519 W NIAGARA ST
TUCSON AZ
85745-3129
US

V. Phone/Fax

Practice location:
  • Phone: 608-320-7938
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: