Healthcare Provider Details

I. General information

NPI: 1861253148
Provider Name (Legal Business Name): LAURA LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 S MARKET ST
GALION OH
44833-3231
US

IV. Provider business mailing address

960 S MARKET ST
GALION OH
44833-3231
US

V. Phone/Fax

Practice location:
  • Phone: 419-961-4337
  • Fax:
Mailing address:
  • Phone: 419-961-4337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: