Provider Demographics
NPI:1801290937
Name:WHITEBREAD, ALIYAH
Entity type:Individual
Prefix:MRS
First Name:ALIYAH
Middle Name:
Last Name:WHITEBREAD
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 1:1300 MARKET ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1420
Mailing Address - Country:US
Mailing Address - Phone:717-737-7905
Mailing Address - Fax:717-737-7908
Practice Address - Street 1:1300 MARKET ST
Practice Address - Street 2:SUITE 5
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-1420
Practice Address - Country:US
Practice Address - Phone:717-737-7905
Practice Address - Fax:717-737-7908
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA25953601376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA049916227OtherDUNS