Provider Demographics
NPI:1154677474
Name:MIRDJALILOVA, BARNO (RN)
Entity Type:Individual
Prefix:MRS
First Name:BARNO
Middle Name:
Last Name:MIRDJALILOVA
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 1:3076 HEWLETT AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-5315
Mailing Address - Country:US
Mailing Address - Phone:614-352-6298
Mailing Address - Fax:
Practice Address - Street 1:3076 HEWLETT AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-5315
Practice Address - Country:US
Practice Address - Phone:614-352-6298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY656087-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse