Provider Demographics
NPI:1699196527
Name:REIKOW, AISHA STEVENSON (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:AISHA
Middle Name:STEVENSON
Last Name:REIKOW
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:MRS
Other - First Name:AISHA
Other - Middle Name:STEVENSON
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:484 WILLIAMSPORT PIKE # 285
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-5707
Mailing Address - Country:US
Mailing Address - Phone:610-850-4713
Mailing Address - Fax:207-881-4771
Practice Address - Street 1:13215 BROOK LANE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2174
Practice Address - Country:US
Practice Address - Phone:301-733-0331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-19
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176974363LP0808X
MDAC003049363LP0808X
WV87515363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health