Provider Demographics
NPI:1154645950
Name:WALCOTT, AISHA (LPN)
Entity Type:Individual
Prefix:
First Name:AISHA
Middle Name:
Last Name:WALCOTT
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 1:489 BAINBRIDGE ST
Mailing Address - Street 2:BASEMENT
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-2010
Mailing Address - Country:US
Mailing Address - Phone:347-529-7088
Mailing Address - Fax:
Practice Address - Street 1:489 BAINBRIDGE ST
Practice Address - Street 2:BASEMENT
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-2010
Practice Address - Country:US
Practice Address - Phone:347-529-7088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300243164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse