| Doctor Name: | JODI LEWIS |
| NPI Number: | 1538536610 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | R195955-8 |
| Business Practice Address: | 560 W Fir Ave Fergus Falls, MN - 565371364 |
| Business Phone Number: | 2189988320 |
| Business Fax Number: | 2189988352 |
| Mailing Address: | 560 W Fir Ave, FERGUS FALLS |
| State: | MN |
| Postal Code: | 565371364 |
| Phone Number: | 2189988320 |
| Fax Number: | 2189988352 |
| NPI Enumeration Date: | 08/25/2015 |
| NPI Last Update Date: | 08/25/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251K00000X |
| License Number: | R195955-8 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Public Health or Welfare |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |