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Individual

DEADRA L NISBETH-LEWIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
2312 SW IMPORT DR, PORT ST LUCIE, FL 34953-5796
(772) 207-8588
Mailing address
2312 SW IMPORT DR, PORT ST LUCIE, FL 34953-5796

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary

Other

Enumeration date
06/14/2018
Last updated
06/14/2018
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