MEDICARE: ASHA L ISMAEL CNA

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
1	376K00000X	Nurse's Aide		IL

General Provider Information

NPI Number	:	1821462227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHA L ISMAEL CNA

Provider Business Mailing Address
First Line	:	PO BOX 3326
Second Line	:
City	:	MUNSTER
State	:	IN
Zip	:	46321-0326
Country	:	US
Telephone Number	:	708-505-9386
Fax Number	:

Provider Business Practice Location Address
First Line	:	2405 ARTHUR ST
Second Line	:	107
City	:	GARY
State	:	IN
Zip	:	46404-3559
Country	:	US
Telephone Number	:	708-505-9386
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2015
Last Update Date	:	11/23/2015

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