Provider Demographics
NPI:1164148185
Name:NOOKS, ALISA J
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:J
Last Name:NOOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4751 RUSHWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-3614
Mailing Address - Country:US
Mailing Address - Phone:937-219-8368
Mailing Address - Fax:
Practice Address - Street 1:4751 RUSHWOOD CIR
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-3614
Practice Address - Country:US
Practice Address - Phone:937-219-8368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide