Provider Demographics
NPI:1548441512
Name:WING, KYISHA LATORA
Entity type:Individual
Prefix:MS
First Name:KYISHA
Middle Name:LATORA
Last Name:WING
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 1:201 WEBSTER ST
Mailing Address - Street 2:APARTMENT B-5
Mailing Address - City:WOODBINE
Mailing Address - State:NJ
Mailing Address - Zip Code:08270-2067
Mailing Address - Country:US
Mailing Address - Phone:609-741-4191
Mailing Address - Fax:
Practice Address - Street 1:201 WEBSTER ST
Practice Address - Street 2:APARTMENT B-5
Practice Address - City:WOODBINE
Practice Address - State:NJ
Practice Address - Zip Code:08270-2067
Practice Address - Country:US
Practice Address - Phone:609-741-4191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0606941482251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care