Individual
NICOLE LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSS
Contact information
Practice address
1190 BROADWAY ST NE, SALEM, OR 97301-1141
(503) 393-4273
Mailing address
469 GREGORY LN SE, SALEM, OR 97302-4823
(503) 851-8161
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
THW000110212
OR
175T00000X
Peer Specialist
—
—
Other
Enumeration date
01/09/2024
Last updated
01/09/2024
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