Provider Demographics
NPI:1124270699
Name:NGUYEN, ALISHA CAMILLE (LPN)
Entity type:Individual
Prefix:MRS
First Name:ALISHA
Middle Name:CAMILLE
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 WHIPPOORWILL LN
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44511-3365
Mailing Address - Country:US
Mailing Address - Phone:330-720-3504
Mailing Address - Fax:
Practice Address - Street 1:3815 WHIPPOORWILL LN
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44511-3365
Practice Address - Country:US
Practice Address - Phone:330-720-3504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-131940164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2729686Medicaid