Provider Demographics
NPI:1588542997
Name:LEWIS, LA' SHANNON UNIQUE
Entity type:Individual
Prefix:
First Name:LA' SHANNON
Middle Name:UNIQUE
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 1:3112 N 54TH ST # A
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-3561
Mailing Address - Country:US
Mailing Address - Phone:402-995-1471
Mailing Address - Fax:
Practice Address - Street 1:3112 N 54TH ST # A
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-3561
Practice Address - Country:US
Practice Address - Phone:402-995-1471
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 Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide