Provider Demographics
NPI:1598033003
Name:WASHINGTON, MICHAEL AHMED (LPN)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:AHMED
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 ROBIN HILL PL
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-5710
Mailing Address - Country:US
Mailing Address - Phone:631-835-3648
Mailing Address - Fax:631-236-5932
Practice Address - Street 1:54 ROBIN HILL PL
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-5710
Practice Address - Country:US
Practice Address - Phone:631-835-3648
Practice Address - Fax:631-236-5932
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307307164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse