Provider Demographics
NPI:1588890750
Name:LEWIS-JONES, ANGELIQUE M (RD)
Entity type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:M
Last Name:LEWIS-JONES
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ANGELIQUE
Other - Middle Name:M
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-7390
Mailing Address - Fax:704-384-5669
Practice Address - Street 1:1718 E 4TH ST
Practice Address - Street 2:SUITE 207
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3261
Practice Address - Country:US
Practice Address - Phone:704-384-7390
Practice Address - Fax:704-384-5669
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002457133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered