Provider Demographics
NPI:1366210007
Name:CARGILL, AIESHA MCKEBA (LPN)
Entity type:Individual
Prefix:
First Name:AIESHA
Middle Name:MCKEBA
Last Name:CARGILL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 SAINT JOHNS PL APT 4B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-2751
Mailing Address - Country:US
Mailing Address - Phone:941-999-0804
Mailing Address - Fax:
Practice Address - Street 1:1228 SAINT JOHNS PL APT 4B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-2751
Practice Address - Country:US
Practice Address - Phone:941-999-0804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY347133164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse