Provider Demographics
NPI:1003523259
Name:HACHEM, AMIRA (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:AMIRA
Middle Name:
Last Name:HACHEM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18220 SNOW AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-4364
Mailing Address - Country:US
Mailing Address - Phone:313-502-7755
Mailing Address - Fax:
Practice Address - Street 1:18220 SNOW AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4364
Practice Address - Country:US
Practice Address - Phone:313-502-7755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704341530363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily