Provider Demographics
NPI:1528396637
Name:SHAKOOR, AAISHA D (RN)
Entity Type:Individual
Prefix:
First Name:AAISHA
Middle Name:D
Last Name:SHAKOOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 W OAK LEAF DR UNIT 18
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-4458
Mailing Address - Country:US
Mailing Address - Phone:414-762-6514
Mailing Address - Fax:414-762-6514
Practice Address - Street 1:130 W OAK LEAF DR UNIT 18
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-4458
Practice Address - Country:US
Practice Address - Phone:414-762-6514
Practice Address - Fax:414-762-6514
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI106751-030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38224400OtherFORWARD HEALTH