Provider Demographics
NPI:1154675858
Name:HEMMAT, MAHDI (RN)
Entity Type:Individual
Prefix:
First Name:MAHDI
Middle Name:
Last Name:HEMMAT
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 S 71ST ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53219-2509
Mailing Address - Country:US
Mailing Address - Phone:414-793-9674
Mailing Address - Fax:
Practice Address - Street 1:2500 S 71ST ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53219-2509
Practice Address - Country:US
Practice Address - Phone:414-793-9674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI191416-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse