Provider Demographics
NPI:1104906262
Name:LEWIS, VEDA ELAINE (RN,LMT)
Entity type:Individual
Prefix:MS
First Name:VEDA
Middle Name:ELAINE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RN,LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 OLD FERRY LANDING RD
Mailing Address - Street 2:
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-4862
Mailing Address - Country:US
Mailing Address - Phone:318-305-5967
Mailing Address - Fax:318-253-6463
Practice Address - Street 1:193 OLD FERRY LANDING RD
Practice Address - Street 2:
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-4821
Practice Address - Country:US
Practice Address - Phone:318-305-5967
Practice Address - Fax:318-253-6463
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN034595163W00000X, 163WH1000X
LALA1364-01163WM1400X
LARN034595-LA1364-01163WP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
No163W00000XNursing Service ProvidersRegistered Nurse
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WP0000XNursing Service ProvidersRegistered NursePain Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
G9211OtherBLUE CROSS/BLUE SHIELD