Provider Demographics
NPI:1962289637
Name:LEWISH, REBECCA
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:LEWISH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BECCA
Other - Middle Name:
Other - Last Name:LEWISH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 MADISON ST APT 530
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-1765
Mailing Address - Country:US
Mailing Address - Phone:302-373-6614
Mailing Address - Fax:
Practice Address - Street 1:100 MADISON ST APT 530
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208-1765
Practice Address - Country:US
Practice Address - Phone:302-373-6614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4358133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered