Provider Demographics
NPI:1548768286
Name:BRYER, LAKESHA ANTIONETTE
Entity Type:Individual
Prefix:
First Name:LAKESHA
Middle Name:ANTIONETTE
Last Name:BRYER
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:PO BOX 531001
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45253-1001
Mailing Address - Country:US
Mailing Address - Phone:513-376-2073
Mailing Address - Fax:
Practice Address - Street 1:7451 COLERAIN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-5307
Practice Address - Country:US
Practice Address - Phone:513-376-2073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
OH82-3961918374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide