Provider Demographics
NPI:1558110122
Name:MCGUIRE, KANISHA NADDINE (RN)
Entity type:Individual
Prefix:
First Name:KANISHA
Middle Name:NADDINE
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KANISHA
Other - Middle Name:NADDINE
Other - Last Name:TROTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:11415 135TH AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-3125
Mailing Address - Country:US
Mailing Address - Phone:347-372-0978
Mailing Address - Fax:
Practice Address - Street 1:11415 135TH AVE APT 2
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-3125
Practice Address - Country:US
Practice Address - Phone:347-372-0978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY787518-01163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health