Provider Demographics
NPI:1194318683
Name:LEWIS, JUDITH FRANCIS
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:FRANCIS
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 DAISY DR
Mailing Address - Street 2:
Mailing Address - City:SHINNSTON
Mailing Address - State:WV
Mailing Address - Zip Code:26431-7227
Mailing Address - Country:US
Mailing Address - Phone:304-695-6200
Mailing Address - Fax:
Practice Address - Street 1:61 DAISY DR
Practice Address - Street 2:
Practice Address - City:SHINNSTON
Practice Address - State:WV
Practice Address - Zip Code:26431-7227
Practice Address - Country:US
Practice Address - Phone:304-695-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVF9085713747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant