1205241627 NPI number — RASHA MOHAMED RIAD APRN, FNP-C

Table of content: RASHA MOHAMED RIAD APRN, FNP-C (NPI 1205241627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205241627 NPI number — RASHA MOHAMED RIAD APRN, FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIAD
Provider First Name:
RASHA
Provider Middle Name:
MOHAMED
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, FNP-C
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:
1205241627
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
505 S BURG ST
Provider Second Line Business Mailing Address:
300
Provider Business Mailing Address City Name:
KIMBALL
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
69145-1313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-235-1951
Provider Business Mailing Address Fax Number:
308-235-2403

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 EAST 20TH STREET
Provider Second Line Business Practice Location Address:
300
Provider Business Practice Location Address City Name:
CHEYENNE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-633-7444
Provider Business Practice Location Address Fax Number:
307-996-1595
Provider Enumeration Date:
06/24/2014

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: 363LF0000X , with the licence number:  28979.1331 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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