Provider Demographics
NPI:1861401564
Name:LEWIS, MARCIA A (CRNA)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:A
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75833-0123
Mailing Address - Country:US
Mailing Address - Phone:903-536-3582
Mailing Address - Fax:903-536-3582
Practice Address - Street 1:643 I-45 SOUTH
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340
Practice Address - Country:US
Practice Address - Phone:936-291-3200
Practice Address - Fax:936-291-2061
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX424871367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered