Individual
ELLEN A LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1541 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 626-0000
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
(318) 626-0287
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
AP05349
LA
363LF0000X
Family Nurse Practitioner
Primary
AP05349
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1028631
—
LA
01
—
3B473F600
MEDICARE - PTAN
LA
Enumeration date
01/08/2008
Last updated
06/11/2024
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