Provider Demographics
NPI:1376254938
Name:LONGMIRE, LUCY ANN
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:ANN
Last Name:LONGMIRE
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 1:5740 DAVEY AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45224-2967
Mailing Address - Country:US
Mailing Address - Phone:513-290-9050
Mailing Address - Fax:
Practice Address - Street 1:5740 DAVEY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224-2967
Practice Address - Country:US
Practice Address - Phone:513-290-9050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X
OH372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive Care