Provider Demographics
NPI:1770065518
Name:ANDERSON, ALISHA NICOLE
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:NICOLE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALISHA
Other - Middle Name:NICOLE
Other - Last Name:RITENOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 CANAL ST W
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:OH
Mailing Address - Zip Code:44662-1169
Mailing Address - Country:US
Mailing Address - Phone:330-409-5406
Mailing Address - Fax:
Practice Address - Street 1:820 MCKINLEY AVE SW
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:OH
Practice Address - Zip Code:44613-1446
Practice Address - Country:US
Practice Address - Phone:234-458-1498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide