MEDICARE: MS. LONNESHA DOMIMIQUE BAILEY STNA

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	164W00000X	Licensed Practical Nurse	186145	OH
2	376J00000X	Homemaker

General Provider Information

NPI Number	:	1578151684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LONNESHA DOMIMIQUE BAILEY STNA

Provider Business Mailing Address
First Line	:	5530 SAMVER RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45239-7149
Country	:	US
Telephone Number	:	513-501-3850
Fax Number	:

Provider Business Practice Location Address
First Line	:	3225 WESTBROOK DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-2220
Country	:	US
Telephone Number	:	513-206-0026
Fax Number	:

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

Provider Enumeration Date	:	01/05/2021
Last Update Date	:	07/22/2024

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