Basic Information
| Provider Information | |||||||||
| NPI: | 1770005282 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | EILEEN | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | REGISTER DIETITIAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3821 CAMINO SACRAMENTO NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871113913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052981296 | ||||||||
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| Practice Location | |||||||||
| Address1: | 117 E 19TH ST | ||||||||
| Address2: | |||||||||
| City: | ROSWELL | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882015151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5756277000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2017 | ||||||||
| LastUpdateDate: | 07/17/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | NM | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.