Individual
GABRIEL LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
600 EAST BLVD, ELKHART, IN 46514-2483
(574) 294-2621
Mailing address
2508 PRAIRIE MOSS DR, BOSSIER CITY, LA 71111-6736
(602) 826-1395
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
131055
IN
390200000X
Student in an Organized Health Care Education/Training Program
28262442A
IN
Other
Enumeration date
11/04/2020
Last updated
12/12/2020
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