Provider Demographics
NPI:1811522634
Name:HERMITT SOUTH, YASHEIKA
Entity type:Individual
Prefix:
First Name:YASHEIKA
Middle Name:
Last Name:HERMITT SOUTH
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:NORTH 11TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107
Mailing Address - Country:US
Mailing Address - Phone:973-342-8078
Mailing Address - Fax:
Practice Address - Street 1:NORTH 11TH STREET
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107
Practice Address - Country:US
Practice Address - Phone:973-342-8078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335227164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse