Provider Demographics
NPI:1740752922
Name:TENNYSON, LAKEISHA N
Entity Type:Individual
Prefix:
First Name:LAKEISHA
Middle Name:N
Last Name:TENNYSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 SHAFER ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-4937
Mailing Address - Country:US
Mailing Address - Phone:585-730-4343
Mailing Address - Fax:
Practice Address - Street 1:22 SHAFER ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-4937
Practice Address - Country:US
Practice Address - Phone:585-730-4343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334165-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse