Healthcare Provider Details

I. General information

NPI: 1376254938
Provider Name (Legal Business Name): LUCY ANN LONGMIRE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5740 DAVEY AVE
CINCINNATI OH
45224-2967
US

IV. Provider business mailing address

5740 DAVEY AVE
CINCINNATI OH
45224-2967
US

V. Phone/Fax

Practice location:
  • Phone: 513-290-9050
  • Fax:
Mailing address:
  • Phone: 513-290-9050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: