Provider Demographics
NPI:1871759977
Name:LEMON, JUANELL (LMT)
Entity type:Individual
Prefix:
First Name:JUANELL
Middle Name:
Last Name:LEMON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 9TH ST SW
Mailing Address - Street 2:
Mailing Address - City:BANDON
Mailing Address - State:OR
Mailing Address - Zip Code:97411-9554
Mailing Address - Country:US
Mailing Address - Phone:541-290-1948
Mailing Address - Fax:
Practice Address - Street 1:835 9TH ST SW
Practice Address - Street 2:
Practice Address - City:BANDON
Practice Address - State:OR
Practice Address - Zip Code:97411-9554
Practice Address - Country:US
Practice Address - Phone:541-290-1948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13439174400000X
TN290174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist