Provider Demographics
NPI:1255166492
Name:LEWIS, MICHAEL RONELL SR (LPN)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RONELL
Last Name:LEWIS
Suffix:SR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9051 TAG DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-3030
Mailing Address - Country:US
Mailing Address - Phone:513-328-1933
Mailing Address - Fax:
Practice Address - Street 1:9051 TAG DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-3030
Practice Address - Country:US
Practice Address - Phone:513-328-1933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.152493.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse