Provider Demographics
NPI:1073805651
Name:ABUBAKER, NEDIRA
Entity Type:Individual
Prefix:
First Name:NEDIRA
Middle Name:
Last Name:ABUBAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 MILL ST
Mailing Address - Street 2:206
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2259
Mailing Address - Country:US
Mailing Address - Phone:775-378-0671
Mailing Address - Fax:775-348-8043
Practice Address - Street 1:3100 MILL ST
Practice Address - Street 2:206
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-2259
Practice Address - Country:US
Practice Address - Phone:775-378-0671
Practice Address - Fax:775-348-8043
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100511515Medicaid