1730832205 NPI number — MISS ZUMRA MEHMEDOVIC PMHNP

Table of content: MISS ZUMRA MEHMEDOVIC PMHNP (NPI 1730832205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730832205 NPI number — MISS ZUMRA MEHMEDOVIC PMHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEHMEDOVIC
Provider First Name:
ZUMRA
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PMHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730832205
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
226 RUSSELL ST APT R
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVERETT
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02149-4112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-475-7013
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 TOWER PARK DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOBURN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-776-0942
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/03/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  2021161384 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)