Provider Demographics
NPI:1144914391
Name:HYPPOLITE, AISHATU M
Entity type:Individual
Prefix:
First Name:AISHATU
Middle Name:M
Last Name:HYPPOLITE
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 1:3966 KINGSBROOK BLVD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-5747
Mailing Address - Country:US
Mailing Address - Phone:848-467-1259
Mailing Address - Fax:
Practice Address - Street 1:3966 KINGSBROOK BLVD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-5747
Practice Address - Country:US
Practice Address - Phone:848-467-1259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN307598163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health