Provider Demographics
NPI:1649571654
Name:DENNIS, LAKEISHA MARIE (RN)
Entity Type:Individual
Prefix:MS
First Name:LAKEISHA
Middle Name:MARIE
Last Name:DENNIS
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 1:28 SAINT PAUL AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07106-1617
Mailing Address - Country:US
Mailing Address - Phone:973-373-5325
Mailing Address - Fax:
Practice Address - Street 1:28 SAINT PAUL AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07106-1617
Practice Address - Country:US
Practice Address - Phone:973-373-5325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-07
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR22478700163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse