Provider Demographics
NPI:1124906334
Name:LEWIS, SIERRA MICHELLE MARIA
Entity type:Individual
Prefix:MRS
First Name:SIERRA
Middle Name:MICHELLE MARIA
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 1:3347 BLACK FOREST LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-7945
Mailing Address - Country:US
Mailing Address - Phone:317-717-2207
Mailing Address - Fax:
Practice Address - Street 1:3347 BLACK FOREST LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46239-7945
Practice Address - Country:US
Practice Address - Phone:317-717-2207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0550703691172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver