Individual provider · Type 1 NPI
Wallie Kanishka, PHYSICIAN ASSISTANT
Student in an Organized Health Care Education/Training Program · Glen Cove, NY
NPI number
1659045235
Active
Practice location
25 Hitching Post Ln
Glen Cove, NY 11542-1625
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Student in an Organized Health Care Education/Training Program Primary | 390200000X | None listed |
Student in an Organized Health Care Education/Training Program: 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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About NPI 1659045235
Wallie Kanishka, PHYSICIAN ASSISTANT's National Provider Identifier is 1659045235, issued on Aug 5, 2021. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Glen Cove, NY. The record was last updated on Aug 5, 2021.