Provider Demographics
NPI:1679717243
Name:NESBITT, DAMIKA DENISE (RN)
Entity Type:Individual
Prefix:
First Name:DAMIKA
Middle Name:DENISE
Last Name:NESBITT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DAMIKA
Other - Middle Name:DENISE
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1510 CHESTER PIKE STE 301
Mailing Address - Street 2:
Mailing Address - City:EDDYSTONE
Mailing Address - State:PA
Mailing Address - Zip Code:19022-1471
Mailing Address - Country:US
Mailing Address - Phone:610-497-7399
Mailing Address - Fax:610-497-7472
Practice Address - Street 1:1510 CHESTER PIKE STE 301
Practice Address - Street 2:
Practice Address - City:EDDYSTONE
Practice Address - State:PA
Practice Address - Zip Code:19022-1471
Practice Address - Country:US
Practice Address - Phone:610-497-7399
Practice Address - Fax:610-497-7472
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN566754163WH0200X, 163WM0102X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023259390001Medicaid