Provider Demographics
NPI:1437942224
Name:LYLES, IESHA S (CNA)
Entity type:Individual
Prefix:
First Name:IESHA
Middle Name:S
Last Name:LYLES
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16162 BURGESS
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-3844
Mailing Address - Country:US
Mailing Address - Phone:313-399-7201
Mailing Address - Fax:
Practice Address - Street 1:19044 W CHICAGO ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-1736
Practice Address - Country:US
Practice Address - Phone:313-409-6467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI230055815830512376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide