Provider Demographics
NPI:1154479319
Name:MIAN, RAFAQAT SULTANA (RN)
Entity Type:Individual
Prefix:
First Name:RAFAQAT
Middle Name:SULTANA
Last Name:MIAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12744 N JACK TONE RD
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-9736
Mailing Address - Country:US
Mailing Address - Phone:550-681-0418
Mailing Address - Fax:
Practice Address - Street 1:12744 N JACK TONE RD
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-9736
Practice Address - Country:US
Practice Address - Phone:550-681-0418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA407179163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse