Healthcare Provider Details

I. General information

NPI: 1912179086
Provider Name (Legal Business Name): BRANDY MARIE LEWIS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2008
Last Update Date: 03/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15800 LITTLE RICHMOND RD
NEW LEBANON OH
45345-9714
US

IV. Provider business mailing address

15800 LITTLE RICHMOND RD
NEW LEBANON OH
45345-9714
US

V. Phone/Fax

Practice location:
  • Phone: 937-687-0903
  • Fax: 937-687-0903
Mailing address:
  • Phone: 937-687-0903
  • Fax: 937-687-0903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN 118233
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: