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1629542857
MIKALA MONTINE LEWIS
GRANITE CITY, IL
NPI
1629542857
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363LA2200X Nurse Practitioner, Adult Health
(Licence: MO 2018038103)
Enumeration Date
2019-01-22
Last Update Date
2019-01-22
Business Address
MIKALA MONTINE LEWIS NP
4816 BAILEY DR
GRANITE CITY, IL 62040-2681
Phone number: 618-791-6926
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Mailing Address
MIKALA MONTINE LEWIS NP
4816 BAILEY DR
GRANITE CITY, IL 62040-2681
Phone number: 618-791-6926
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