MEDICARE: RHONDA JEANNINE LYLES- LEE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347C00000X	Private Vehicle	HNW3693	OH

General Provider Information

NPI Number	:	1508414780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RHONDA JEANNINE LYLES- LEE

Provider Business Mailing Address
First Line	:	1228 E 22ND AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43211-2520
Country	:	US
Telephone Number	:	614-515-3624
Fax Number	:

Provider Business Practice Location Address
First Line	:	1228 E 22ND AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43211-2520
Country	:	US
Telephone Number	:	614-515-3624
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2019
Last Update Date	:	08/30/2019

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