Provider Demographics
NPI:1114748423
Name:LEWIS SMITH, CEREESE N
Entity type:Individual
Prefix:
First Name:CEREESE
Middle Name:N
Last Name:LEWIS SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CEREESE
Other - Middle Name:
Other - Last Name:LEWIS SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MHA, MSN, RN
Mailing Address - Street 1:PO BOX 304867
Mailing Address - Street 2:
Mailing Address - City:ST.THOMAS
Mailing Address - State:VIRGIN ISLANDS
Mailing Address - Zip Code:00803
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 304867
Practice Address - Street 2:
Practice Address - City:ST.THOMAS
Practice Address - State:VIRGIN ISLANDS
Practice Address - Zip Code:00803
Practice Address - Country:UM
Practice Address - Phone:340-642-6773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-19
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI6065163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty