Provider Demographics
NPI:1730813916
Name:TIDWELL, AUSHANAY LASHAYA (CNA)
Entity type:Individual
Prefix:
First Name:AUSHANAY
Middle Name:LASHAYA
Last Name:TIDWELL
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 1:175 WASHINGTON BLVD APT 202
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-5282
Mailing Address - Country:US
Mailing Address - Phone:510-882-1677
Mailing Address - Fax:
Practice Address - Street 1:175 WASHINGTON BLVD APT 202
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-5282
Practice Address - Country:US
Practice Address - Phone:510-882-1677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care