Individual provider · Type 1 NPI

Keisha Musu Fully, LPN

Licensed Practical Nurse · Staten Island, NY

NPI number 1104773803 Active

Practice location

180 Park Hill Ave Apt 5D
Staten Island, NY 10304-4708

Call (347) 596-1489 Map

Specialties and licenses

TaxonomyCodeLicense
Licensed Practical Nurse 164W00000X26NP49873900 (NJ)
Licensed Practical Nurse Primary 164W00000X352421 (NY)

Licensed Practical Nurse: An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.

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About NPI 1104773803

Keisha Musu Fully, LPN's National Provider Identifier is 1104773803, issued on Mar 12, 2026. The primary taxonomy on file is Licensed Practical Nurse (164W00000X), and the practice location is in Staten Island, NY. The record was last updated on Mar 12, 2026.