Provider Demographics
NPI:1972800316
Name:GREEN, AISHA CHANTE
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:CHANTE
Last Name:GREEN
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 1:1944 SIOUX PL
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-4439
Mailing Address - Country:US
Mailing Address - Phone:330-888-8373
Mailing Address - Fax:
Practice Address - Street 1:1944 SIOUX PL
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-4439
Practice Address - Country:US
Practice Address - Phone:330-888-8373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 1366752-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse