MEDICARE: MRS. BRANDI MICKALE LEWIS CNP

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	363LF0000X	Family Nurse Practitioner	APRN.CNP.021012	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740316066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRANDI MICKALE LEWIS CNP

Provider Business Mailing Address
First Line	:	7584 SHEFFIELD CT
Second Line	:
City	:	MACEDONIA
State	:	OH
Zip	:	44056-2272
Country	:	US
Telephone Number	:	330-468-2086
Fax Number	:

Provider Business Practice Location Address
First Line	:	1710 PROSPECT AVE E
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115-2322
Country	:	US
Telephone Number	:	216-645-0146
Fax Number	:	216-781-2023

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

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	03/17/2018

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