Provider Demographics
NPI:1962911636
Name:LEWIS, DENISE
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
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 1:16738 QUAIL BRIAR DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-5342
Mailing Address - Country:US
Mailing Address - Phone:281-682-6047
Mailing Address - Fax:
Practice Address - Street 1:11104 W AIRPORT BLVD STE 107
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-3016
Practice Address - Country:US
Practice Address - Phone:832-770-9125
Practice Address - Fax:832-770-9253
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX708428163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health