Provider Demographics
NPI:1508414780
Name:LYLES- LEE, RHONDA JEANNINE
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:JEANNINE
Last Name:LYLES- LEE
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 1:1228 E 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43211-2520
Mailing Address - Country:US
Mailing Address - Phone:614-515-3624
Mailing Address - Fax:
Practice Address - Street 1:1228 E 22ND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43211-2520
Practice Address - Country:US
Practice Address - Phone:614-515-3624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHHNW3693347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle