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Wallie Kanishka, PHYSICIANASSISTANT
Student in an Organized Health Care Education/Training Program in Glen Cove, New York
NPI 1659045235

Wallie Kanishka is a Student in an Organized Health Care Education/Training Program based in Glen Cove, NY. Wallie Kanishka practices in Glen Cove, NY and has the professional credentials of PHYSICIANASSISTANT. The NPI Number for Wallie Kanishka is 1659045235 and holds a License No. (New York).

The current practice location address for Wallie Kanishka is 25 Hitching Post Ln, Glen Cove, NY and can be reached out via phone at 801-918-4155.

Location: 25 Hitching Post Ln, Glen Cove, NY, 11542-1625
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1659045235
Provider Name
Wallie Kanishka
Credential
PHYSICIANASSISTANT
Provider Entity Type
Individual
Gender
Male
Address
25 Hitching Post Ln, Glen Cove, NY, 11542-1625
Phone Number
801-918-4155
Fax Number
Provider Enumeration Date
08/05/2021
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
25 Hitching Post Ln
City
Glen Cove
State
New York
Zip
11542-1625
Phone Number
801-918-4155
Fax Number
person
Provider Business Mailing Address Details
Address
25 Hitching Post Ln
City
Glen Cove
State
New York
Zip
11542-1625
Phone Number
801-918-4155
Fax Number
person
Provider's Taxonomy Details 1
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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