Provider Demographics
NPI:1134908254
Name:LEWIS, JACQUE RENEE
Entity type:Individual
Prefix:
First Name:JACQUE
Middle Name:RENEE
Last Name:LEWIS
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 1:809 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45123-1246
Mailing Address - Country:US
Mailing Address - Phone:379-030-4139
Mailing Address - Fax:
Practice Address - Street 1:809 SOUTH ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:OH
Practice Address - Zip Code:45123-1246
Practice Address - Country:US
Practice Address - Phone:937-803-0413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide