Provider Demographics
NPI:1720027972
Name:WASHINGTON, AISHA LADI (MS,RD,LD)
Entity Type:Individual
Prefix:MRS
First Name:AISHA
Middle Name:LADI
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:MS,RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 REMINGTON PLAZA CT
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-8599
Mailing Address - Country:US
Mailing Address - Phone:816-572-0471
Mailing Address - Fax:
Practice Address - Street 1:414 REMINGTON PLAZA CT
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-8599
Practice Address - Country:US
Practice Address - Phone:816-572-0471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO359011905Medicaid