Provider Demographics
NPI:1558729418
Name:LEWIS, GENIE (LPN)
Entity Type:Individual
Prefix:
First Name:GENIE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 CARLTON DAVIDSON LN
Mailing Address - Street 2:
Mailing Address - City:COAL GROVE
Mailing Address - State:OH
Mailing Address - Zip Code:45638-2924
Mailing Address - Country:US
Mailing Address - Phone:740-533-0648
Mailing Address - Fax:740-353-1662
Practice Address - Street 1:225 CARLTON DAVIDSON LN
Practice Address - Street 2:
Practice Address - City:COAL GROVE
Practice Address - State:OH
Practice Address - Zip Code:45638-2924
Practice Address - Country:US
Practice Address - Phone:740-533-0648
Practice Address - Fax:740-353-1662
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.149214164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse