Provider Demographics
NPI:1669226312
Name:LEWIS, MARCIE MARIE (LPN)
Entity type:Individual
Prefix:
First Name:MARCIE
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 1:410 WINE ST
Mailing Address - Street 2:
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089-9011
Mailing Address - Country:US
Mailing Address - Phone:570-604-4070
Mailing Address - Fax:
Practice Address - Street 1:410 WINE ST
Practice Address - Street 2:
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089-9011
Practice Address - Country:US
Practice Address - Phone:570-604-4070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN295218164W00000X
OH186936164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse