Provider Demographics
NPI:1740316066
Name:LEWIS, BRANDI MICKALE (CNP)
Entity type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:MICKALE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7584 SHEFFIELD CT
Mailing Address - Street 2:
Mailing Address - City:MACEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44056-2272
Mailing Address - Country:US
Mailing Address - Phone:330-468-2086
Mailing Address - Fax:
Practice Address - Street 1:1710 PROSPECT AVE E
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2322
Practice Address - Country:US
Practice Address - Phone:216-645-0146
Practice Address - Fax:216-781-2023
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.021012363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0228085Medicaid
OH2689327Medicaid