MEDICARE: MIRANDA LEWIS

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	3747P1801X	Personal Care Attendant
2	372600000X	Adult Companion

General Provider Information

NPI Number	:	1922998350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA LEWIS

Provider Business Mailing Address
First Line	:	306 N PINE ST APT 2
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68801-5986
Country	:	US
Telephone Number	:	308-321-2585
Fax Number	:

Provider Business Practice Location Address
First Line	:	306 N PINE ST APT 2
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68801-5986
Country	:	US
Telephone Number	:	308-321-2585
Fax Number	:

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

Provider Enumeration Date	:	07/07/2025
Last Update Date	:	07/07/2025

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Directions to “ MIRANDA LEWIS ” Practice Location

Language	Start Address	Practice Location

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