Provider Demographics
NPI:1326658642
Name:HUMMEL, SHAZA HANAFY (NP)
Entity Type:Individual
Prefix:
First Name:SHAZA
Middle Name:HANAFY
Last Name:HUMMEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8605 SANTA MONICA BLVD # 396329
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4109
Mailing Address - Country:US
Mailing Address - Phone:818-303-1753
Mailing Address - Fax:
Practice Address - Street 1:11945 MAGNOLIA UNIT 102
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607
Practice Address - Country:US
Practice Address - Phone:818-303-1753
Practice Address - Fax:818-518-9017
Is Sole Proprietor?:No
Enumeration Date:2020-08-01
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV864715363LF0000X
COAPN.0996547-NP363LF0000X
CA95009218363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1041152OtherTEXAS BOARD OF NURSING