Doctor Name: | KANIZ FATEMA ISLAM |
NPI Number: | 1366860843 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | RN154095 |
Business Practice Address: | 5209 W Siesta Way Laveen, AZ - 853397179 |
Business Phone Number: | 6025501008 |
Business Fax Number: | |
Mailing Address: | 5209 W Siesta Way, LAVEEN |
State: | AZ |
Postal Code: | 853397179 |
Phone Number: | 6025501008 |
Fax Number: | |
NPI Enumeration Date: | 04/02/2014 |
NPI Last Update Date: | 10/15/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | RN154095 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |