Provider Demographics
NPI:1902438369
Name:LEWIS, LASHERAL CHANEY
Entity Type:Individual
Prefix:
First Name:LASHERAL
Middle Name:CHANEY
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 TANGLE WAY CT
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-7818
Mailing Address - Country:US
Mailing Address - Phone:469-254-3034
Mailing Address - Fax:
Practice Address - Street 1:808 TANGLE WAY CT
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-7818
Practice Address - Country:US
Practice Address - Phone:469-254-3034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider