Individual
JAEKISHA D LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2600 MARBLE AVE NE, ALBUQUERQUE, NM 87106-2058
(505) 272-2479
Mailing address
2600 MARBLE AVE NE, ALBUQUERQUE, NM 87106-2058
(505) 272-2479
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
NM
Other
Enumeration date
09/14/2018
Last updated
09/14/2018
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