Provider Demographics
NPI:1194245738
Name:AVERY INTEGRATIVE HEALTHCARE SERVICES
Entity type:Organization
Organization Name:AVERY INTEGRATIVE HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITONER
Authorized Official - Prefix:
Authorized Official - First Name:TAMIKA
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:262-455-1093
Mailing Address - Street 1:15030 WILDBERRY CREEK CT
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-2241
Mailing Address - Country:US
Mailing Address - Phone:1262-455-1093
Mailing Address - Fax:
Practice Address - Street 1:15030 WILDBERRY CREEK CT
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-2241
Practice Address - Country:US
Practice Address - Phone:1262-455-1093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-25
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty