Provider Demographics
NPI:1699089789
Name:LEWIS, KELLI S (LPN)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:S
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 1:2996 WARDALL AVE
Mailing Address - Street 2:APT 4
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-4960
Mailing Address - Country:US
Mailing Address - Phone:513-290-5492
Mailing Address - Fax:
Practice Address - Street 1:2996 WARDALL AVE
Practice Address - Street 2:APT 4
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-4960
Practice Address - Country:US
Practice Address - Phone:513-290-5492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN129053164W00000X
GALPN081542164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse