Provider Demographics
NPI:1386461838
Name:SECREST, LOIS LEE
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:LEE
Last Name:SECREST
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 1:9647 RICHARD DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5403
Mailing Address - Country:US
Mailing Address - Phone:513-860-5633
Mailing Address - Fax:
Practice Address - Street 1:9647 RICHARD DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5403
Practice Address - Country:US
Practice Address - Phone:513-860-5633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker