Healthcare Provider Details

I. General information

NPI: 1578151684
Provider Name (Legal Business Name): LONNESHA DOMIMIQUE BAILEY STNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 WESTBROOK DR
CINCINNATI OH
45238-2220
US

IV. Provider business mailing address

5530 SAMVER RD
CINCINNATI OH
45239-7149
US

V. Phone/Fax

Practice location:
  • Phone: 513-206-0026
  • Fax:
Mailing address:
  • Phone: 513-501-3850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number186145
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: