Provider Demographics
NPI:1518267772
Name:MANSARAY, ISHA ANITA (LPN)
Entity Type:Individual
Prefix:
First Name:ISHA
Middle Name:ANITA
Last Name:MANSARAY
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 1:4175 CARNATION DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-3805
Mailing Address - Country:US
Mailing Address - Phone:614-806-0172
Mailing Address - Fax:
Practice Address - Street 1:4175 CARNATION DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-3805
Practice Address - Country:US
Practice Address - Phone:614-806-0172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.141717-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse