Provider Demographics
NPI:1386011153
Name:HARAWAY, KISHA
Entity Type:Individual
Prefix:
First Name:KISHA
Middle Name:
Last Name:HARAWAY
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 1:2 LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-2508
Mailing Address - Country:US
Mailing Address - Phone:567-424-6045
Mailing Address - Fax:
Practice Address - Street 1:2 LAUREL LN
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2508
Practice Address - Country:US
Practice Address - Phone:567-424-6045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH333227163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse