Provider Demographics
NPI:1427622323
Name:KALIEF-WILSON, KHADIJAH
Entity type:Individual
Prefix:
First Name:KHADIJAH
Middle Name:
Last Name:KALIEF-WILSON
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 1:7928 HOY CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-3315
Mailing Address - Country:US
Mailing Address - Phone:856-993-8669
Mailing Address - Fax:
Practice Address - Street 1:7928 HOY CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-3315
Practice Address - Country:US
Practice Address - Phone:856-993-8669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.178402.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse