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General NPI Number Information
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NPI Number | 1598059297
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Entity Type | Individual
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Provider Name | DORETTE F LEWIS-SENIOR ND
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Gender | Female
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Dates
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Enumeration Date | 05/31/2011
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Last Update Date | 10/14/2015
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Provider Practice Location Address
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Address Line | 239 PLATTSVILLE RD
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City | TRUMBULL
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State | CT
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Zip | 06611-3427
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Country | US
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Telephone | 203-374-5309
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Fax | 203-374-6856
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Provider Business Mailing Address
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Address Line | 239 PLATTSVILLE RD
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City | TRUMBULL
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State | CT
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Zip | 06611-3427
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Country | US
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Telephone | 203-374-5309
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Fax | 203-374-6856
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 000302
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 163WN1003X
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Taxonomy Name | Nutrition Support Registered Nurse
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License Number | 461148
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License Number State | NY
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