| Doctor Name: | JACQUELINE LENORE LEWIS |
| NPI Number: | 1104943810 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | FCL-079-056 |
| Business Practice Address: | 197 E Aiken Rd Eden, NC - 272882201 |
| Business Phone Number: | 3366237715 |
| Business Fax Number: | |
| Mailing Address: | Po Box 1115, REIDSVILLE |
| State: | NC |
| Postal Code: | 273231115 |
| Phone Number: | 3365898197 |
| Fax Number: | |
| NPI Enumeration Date: | 03/26/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 376G00000X |
| License Number: | FCL-079-056 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Nursing Service Related Providers |
| Taxonomy Classification: | Nursing Home Administrator |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual, often licensed by the state, who is responsible for the management of a nursing home. |