Provider Demographics
NPI:1548000508
Name:LEWIS, PATRICIA ELIZABETH (CSFA)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ELIZABETH
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:ELIZABETH
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CSFA
Mailing Address - Street 1:1200 KENSINGTON DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-3762
Mailing Address - Country:US
Mailing Address - Phone:469-445-5367
Mailing Address - Fax:
Practice Address - Street 1:1441 N BECKLEY AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1201
Practice Address - Country:US
Practice Address - Phone:214-947-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90723246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant