Provider Demographics
NPI:1093416604
Name:ANUFRIYEVA, NINA ALEKSANDROVNA (NP)
Entity Type:Individual
Prefix:MISS
First Name:NINA
Middle Name:ALEKSANDROVNA
Last Name:ANUFRIYEVA
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:1711 ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906-4606
Mailing Address - Country:US
Mailing Address - Phone:517-388-6111
Mailing Address - Fax:
Practice Address - Street 1:1711 ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-4606
Practice Address - Country:US
Practice Address - Phone:517-388-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704311994363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily