Individual
JACOREON LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4306 S GRAND ST, MONROE, LA 71202-6322
(913) 220-3153
Mailing address
8326 KELWOOD AVE, BATON ROUGE, LA 70806
(913) 220-3153
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
01/15/2020
Last updated
02/03/2020
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