Individual
MRS. HAZEL IRENE LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
1125 LOGAN AVE, LAFAYETTE, IN 47905-1829
(765) 474-6858
Mailing address
1125 LOGAN AVE, LAFAYETTE, IN 47905-1829
(765) 474-6858
Taxonomy
Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
37000715A
IN
Other
Enumeration date
11/09/2009
Last updated
11/09/2009
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