Healthcare Provider Details

I. General information

NPI: 1568304871
Provider Name (Legal Business Name): MARIAH R LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11347 LIPPELMAN RD APT 245
CINCINNATI OH
45246-4031
US

IV. Provider business mailing address

11347 LIPPELMAN RD APT 245
CINCINNATI OH
45246-4031
US

V. Phone/Fax

Practice location:
  • Phone: 513-290-6009
  • Fax:
Mailing address:
  • Phone: 513-290-6009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number603077290825
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: