Healthcare Provider Details

I. General information

NPI: 1558251884
Provider Name (Legal Business Name): JIMMINA LEWIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2765 E 55TH ST STE 8
CLEVELAND OH
44104-2856
US

IV. Provider business mailing address

2765 E 55TH ST STE 8
CLEVELAND OH
44104-2856
US

V. Phone/Fax

Practice location:
  • Phone: 216-326-2229
  • Fax:
Mailing address:
  • Phone: 216-326-2229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number529495
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: