Provider Demographics
NPI:1386284818
Name:LEWIS, MONICA AARON (BA)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:AARON
Last Name:LEWIS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:AARON
Other - Last Name:DANNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 15
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74802-0015
Mailing Address - Country:US
Mailing Address - Phone:405-481-5818
Mailing Address - Fax:
Practice Address - Street 1:209 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:OKEMAH
Practice Address - State:OK
Practice Address - Zip Code:74859-2618
Practice Address - Country:US
Practice Address - Phone:918-623-2922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator