Provider Demographics
NPI:1750085262
Name:TAYLOR, KANIESHA (NIESHA) RASHELLE (LPN-IP)
Entity type:Individual
Prefix:
First Name:KANIESHA (NIESHA)
Middle Name:RASHELLE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LPN-IP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06513-3100
Mailing Address - Country:US
Mailing Address - Phone:203-562-7222
Mailing Address - Fax:
Practice Address - Street 1:118 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513-3199
Practice Address - Country:US
Practice Address - Phone:203-562-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT029574164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse