Provider Demographics
NPI:1083920011
Name:HILL, TYNISHA LASHAE (LPN)
Entity Type:Individual
Prefix:
First Name:TYNISHA
Middle Name:LASHAE
Last Name:HILL
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 1:28 REIDS GRV
Mailing Address - Street 2:
Mailing Address - City:W HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14586-9653
Mailing Address - Country:US
Mailing Address - Phone:585-285-3937
Mailing Address - Fax:
Practice Address - Street 1:28 REIDS GRV
Practice Address - Street 2:
Practice Address - City:W HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14586-9653
Practice Address - Country:US
Practice Address - Phone:585-285-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301482-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse