Individual
MISS TANISHA LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10543 S CRATER RD, SOUTH PRINCE GEORGE, VA 23805-7333
(800) 805-6989
Mailing address
111 MERCHANT MAN CT, WILLIAMSBURG, VA 23185-5369
(309) 922-0911
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
0002103538
VA
Other
Enumeration date
01/25/2024
Last updated
01/25/2024
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