Provider Demographics
NPI:1003319930
Name:KHAN, IQRA (RN)
Entity Type:Individual
Prefix:
First Name:IQRA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 PALISADE AVE
Mailing Address - Street 2:GOLDEN HEALTHCARE
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026
Mailing Address - Country:US
Mailing Address - Phone:914-906-4004
Mailing Address - Fax:
Practice Address - Street 1:242 PALISADE AVE
Practice Address - Street 2:GOLDEN HEALTHCARE
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026
Practice Address - Country:US
Practice Address - Phone:877-469-4334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP07623200163WI0500X, 163WC0400X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WC0400XNursing Service ProvidersRegistered NurseCase Management