Provider Demographics
NPI:1538421789
Name:LEWIS, DIANE SMITH (RN)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:SMITH
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38195 PAT SMITH RD
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:LA
Mailing Address - Zip Code:70452-5629
Mailing Address - Country:US
Mailing Address - Phone:985-788-8568
Mailing Address - Fax:
Practice Address - Street 1:38195 PAT SMITH RD
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:LA
Practice Address - Zip Code:70452-5629
Practice Address - Country:US
Practice Address - Phone:985-788-8568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN005252163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health