Individual
DIANE LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1751 36TH AVE S APT 112, GRAND FORKS, ND 58201-7348
(701) 335-3491
Mailing address
1751 36TH AVE S APT 112, GRAND FORKS, ND 58201-7348
(701) 335-3491
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
1464800
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1464800
—
ND
Enumeration date
12/01/2020
Last updated
12/01/2020
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