Provider Demographics
NPI:1073234639
Name:KANIZ F ISLAM
Entity Type:Organization
Organization Name:KANIZ F ISLAM
Other - Org Name:PECAN HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KANIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:ISLAM
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:602-550-1008
Mailing Address - Street 1:5209 W SIESTA WAY
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-7179
Mailing Address - Country:US
Mailing Address - Phone:602-550-1008
Mailing Address - Fax:
Practice Address - Street 1:5209 W SIESTA WAY
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-7179
Practice Address - Country:US
Practice Address - Phone:602-550-1008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-12
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care