Provider Demographics
NPI:1114590932
Name:DZANDU, FARHIA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:FARHIA
Middle Name:
Last Name:DZANDU
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45300 CHERRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-5073
Mailing Address - Country:US
Mailing Address - Phone:734-981-3968
Mailing Address - Fax:
Practice Address - Street 1:45300 CHERRY HILL RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-5073
Practice Address - Country:US
Practice Address - Phone:734-981-3968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704303472163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse