Individual
STEPHANIE LOUISE LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDN
Contact information
Practice address
43 TOWN CENTER SQ STE 102, HATTIESBURG, MS 39402-7040
(800) 945-9479
Mailing address
107 BLUEBERRY LN, STORMVILLE, NY 12582-5340
(845) 494-1385
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
133V00000X
Registered Dietitian
Primary
—
—
174H00000X
Health Educator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
236
—
DC
01
—
568946544
BCBS
—
01
—
5874
HEALTH PARTNERS
—
Enumeration date
01/04/2023
Last updated
01/04/2023
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