Provider Demographics
NPI:1275143778
Name:ABDISHOO, MARYAM (NP)
Entity Type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:ABDISHOO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15095 N THOMPSON PEAK PKWY UNIT 2005
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2878
Mailing Address - Country:US
Mailing Address - Phone:602-321-8014
Mailing Address - Fax:
Practice Address - Street 1:15095 N THOMPSON PEAK PKWY UNIT 2005
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2878
Practice Address - Country:US
Practice Address - Phone:602-321-8014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-09
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZF08200198363LF0000X
CT11977363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty