Provider Demographics
NPI:1912179086
Name:LEWIS, BRANDY MARIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:MARIE
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 1:15800 LITTLE RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:NEW LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45345-9714
Mailing Address - Country:US
Mailing Address - Phone:937-687-0903
Mailing Address - Fax:937-687-0903
Practice Address - Street 1:15800 LITTLE RICHMOND RD
Practice Address - Street 2:
Practice Address - City:NEW LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45345-9714
Practice Address - Country:US
Practice Address - Phone:937-687-0903
Practice Address - Fax:937-687-0903
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-29
Last Update Date:2008-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 118233164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse