Provider Demographics
NPI:1407115819
Name:JAITEH, ISATOU (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ISATOU
Middle Name:
Last Name:JAITEH
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 1:200 E 131ST ST
Mailing Address - Street 2:APT 6K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-3471
Mailing Address - Country:US
Mailing Address - Phone:646-643-8261
Mailing Address - Fax:
Practice Address - Street 1:200 E 131ST ST
Practice Address - Street 2:APT 6K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-3471
Practice Address - Country:US
Practice Address - Phone:646-643-8261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309318164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse