Provider Demographics
NPI:1053977926
Name:TEW, ALISHA MICHELLE (CMA, CNA, PA)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:MICHELLE
Last Name:TEW
Suffix:
Gender:F
Credentials:CMA, CNA, PA
Other - Prefix:
Other - First Name:ALISHA
Other - Middle Name:MICHELLE
Other - Last Name:DAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMA, CNA, PA , OT
Mailing Address - Street 1:2785 N 5TH W
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-1157
Mailing Address - Country:US
Mailing Address - Phone:208-970-6415
Mailing Address - Fax:
Practice Address - Street 1:3031 CHAPARRAL DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7277
Practice Address - Country:US
Practice Address - Phone:208-524-1614
Practice Address - Fax:208-970-6415
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty