MEDICARE: JIMMINA LEWIS RN

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	163WC1500X	Community Health Registered Nurse	529495	OH

General Provider Information

NPI Number	:	1558251884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIMMINA LEWIS RN

Provider Business Mailing Address
First Line	:	2765 E 55TH ST STE 8
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44104-2856
Country	:	US
Telephone Number	:	216-326-2229
Fax Number	:

Provider Business Practice Location Address
First Line	:	2765 E 55TH ST STE 8
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44104-2856
Country	:	US
Telephone Number	:	216-326-2229
Fax Number	:

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

Provider Enumeration Date	:	07/08/2025
Last Update Date	:	07/08/2025

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