MEDICARE: DASIA MARIE LEWIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver	VJ679121	OH
2	347C00000X	Private Vehicle	VJ679121	OH
3	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1487352423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DASIA MARIE LEWIS

Provider Business Mailing Address
First Line	:	3488 VINE ST APT 1
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45220-1333
Country	:	US
Telephone Number	:	859-312-7604
Fax Number	:

Provider Business Practice Location Address
First Line	:	3488 VINE ST APT 1
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45220-1333
Country	:	US
Telephone Number	:	859-312-7604
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2023
Last Update Date	:	02/20/2023

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Directions to “ DASIA MARIE LEWIS ” Practice Location

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