Provider Demographics
NPI:1700340213
Name:LEWIS, MONICA ROCHELLE
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:ROCHELLE
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 1:1174 TOWNE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45216-2228
Mailing Address - Country:US
Mailing Address - Phone:513-349-5139
Mailing Address - Fax:
Practice Address - Street 1:1174 TOWNE ST APT 1
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45216-2228
Practice Address - Country:US
Practice Address - Phone:513-349-5139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN-139050164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty