Provider Demographics
NPI:1295206068
Name:LEWIS, JERRIE LANELL
Entity Type:Individual
Prefix:
First Name:JERRIE
Middle Name:LANELL
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 QUEEN CITY AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-2952
Mailing Address - Country:US
Mailing Address - Phone:513-519-5726
Mailing Address - Fax:
Practice Address - Street 1:2506 QUEEN CITY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-2952
Practice Address - Country:US
Practice Address - Phone:513-519-5726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide