Provider Demographics
NPI:1336530658
Name:LEWIS, TRACEY CAROLYN-LEE
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:CAROLYN-LEE
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 1:1506 TWIN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-4035
Mailing Address - Country:US
Mailing Address - Phone:770-543-9412
Mailing Address - Fax:
Practice Address - Street 1:1506 TWIN OAKS DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-4035
Practice Address - Country:US
Practice Address - Phone:770-543-9412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty
No171W00000XOther Service ProvidersContractorGroup - Single Specialty