Provider Demographics
NPI:1497549752
Name:LEWIS, MARTHA B (OTHER)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:B
Last Name:LEWIS
Suffix:
Gender:F
Credentials:OTHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3994 HAWTHORNE LN
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:WY
Mailing Address - Zip Code:83014-9195
Mailing Address - Country:US
Mailing Address - Phone:307-690-1502
Mailing Address - Fax:
Practice Address - Street 1:3994 HAWTHORNE LN
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:WY
Practice Address - Zip Code:83014-9195
Practice Address - Country:US
Practice Address - Phone:307-690-1502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach