Provider Demographics
NPI:1073375929
Name:PRITCHETT, LENDOUR AISHA (RN)
Entity Type:Individual
Prefix:
First Name:LENDOUR
Middle Name:AISHA
Last Name:PRITCHETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LENDOUR
Other - Middle Name:AISHA
Other - Last Name:GBOLLIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7209 LYNNBROOK CT
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-2630
Mailing Address - Country:US
Mailing Address - Phone:321-223-7857
Mailing Address - Fax:
Practice Address - Street 1:7209 LYNNBROOK CT
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-2630
Practice Address - Country:US
Practice Address - Phone:916-900-8890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95046520163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA345920107OtherRCFE LICENSE NUMBER