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General NPI Number Information
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NPI Number | 1740630284
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Entity Type | Individual
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Provider Name | WANEL N LEWIS
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Gender | Female
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Dates
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Enumeration Date | 06/15/2016
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Last Update Date | 06/15/2016
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Provider Practice Location Address
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Address Line | 1106 MACARTHUR DR STE 6
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City | ALEXANDRIA
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State | LA
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Zip | 71303-3122
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Country | US
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Telephone | 318-441-2229
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Fax | 318-442-2755
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Provider Business Mailing Address
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Address Line | 1106 MACARTHUR DR STE 6
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City | ALEXANDRIA
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State | LA
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Zip | 71303-3122
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Country | US
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Telephone | 318-441-2229
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Fax | 318-442-2755
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 15523
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License Number State | LA
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