Provider Demographics
NPI:1487959854
Name:WALUSAYI, KATHY AYIYA (LPN)
Entity type:Individual
Prefix:MISS
First Name:KATHY
Middle Name:AYIYA
Last Name:WALUSAYI
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 1:12200 W FLORIST AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-2122
Mailing Address - Country:US
Mailing Address - Phone:414-520-1977
Mailing Address - Fax:
Practice Address - Street 1:12200 W FLORIST AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-2122
Practice Address - Country:US
Practice Address - Phone:414-520-1977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-17
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI309834164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse