MEDICARE: AISHAH ALLEN RN

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	163W00000X	Registered Nurse	421954	OH

General Provider Information

NPI Number	:	1124472386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AISHAH ALLEN RN

Provider Business Mailing Address
First Line	:	PO BOX 181003
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-7003
Country	:	US
Telephone Number	:	216-323-8753
Fax Number	:

Provider Business Practice Location Address
First Line	:	2436 EDGERTON RD
Second Line	:
City	:	UNIVERSITY HEIGHTS
State	:	OH
Zip	:	44118-4411
Country	:	US
Telephone Number	:	216-323-8753
Fax Number	:

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

Provider Enumeration Date	:	04/14/2016
Last Update Date	:	04/14/2016

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