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Individual

GABRIELLE LEWIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
108 W MARKET ST, BLOOMINGTON, IL 61701-3918
(309) 827-5351
Mailing address
108 W MARKET ST, BLOOMINGTON, IL 61701-3918
(309) 827-5351

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043.102979
IL

Other

Enumeration date
05/02/2016
Last updated
05/02/2016
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