Provider Demographics
NPI:1770019960
Name:HUNTLEY, AISHARA BLAINE (STNA)
Entity Type:Individual
Prefix:MISS
First Name:AISHARA
Middle Name:BLAINE
Last Name:HUNTLEY
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43605-3623
Mailing Address - Country:US
Mailing Address - Phone:567-377-1108
Mailing Address - Fax:
Practice Address - Street 1:1320 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43605-3623
Practice Address - Country:US
Practice Address - Phone:567-377-1108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-07
Last Update Date:2017-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide