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NPI Code Detail

MEDICARE: MS. CONNEILA AIYSHA GARRIS LPN

MEDICARE: MS. CONNEILA AIYSHA GARRIS LPN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical NursePN302036PA

General Provider Information

NPI Number : 1750248480
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CONNEILA AIYSHA GARRIS LPN
Provider Business Mailing Address
First Line : 1902 W GODFREY AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19141
Country : US
Telephone Number : 267-393-1714
Fax Number :
Provider Business Practice Location Address
First Line : 7307 BUIST AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19153-2204
Country : US
Telephone Number : 610-998-5794
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2026
Last Update Date : 01/06/2026

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