Provider Demographics
NPI:1437644432
Name:ONAMUTI, AISHA MICHELLE (LPN)
Entity Type:Individual
Prefix:
First Name:AISHA
Middle Name:MICHELLE
Last Name:ONAMUTI
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 1:7095 ELMWOOD RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30340-1864
Mailing Address - Country:US
Mailing Address - Phone:317-384-8165
Mailing Address - Fax:
Practice Address - Street 1:7095 ELMWOOD RIDGE CT
Practice Address - Street 2:
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340-1864
Practice Address - Country:US
Practice Address - Phone:317-384-8165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA830994376251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health