Provider Demographics
NPI:1336699206
Name:MOHAMMAD, ANJUM (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ANJUM
Middle Name:
Last Name:MOHAMMAD
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3992 POWELL RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:19425-3854
Mailing Address - Country:US
Mailing Address - Phone:732-222-8098
Mailing Address - Fax:
Practice Address - Street 1:3992 POWELL RD
Practice Address - Street 2:
Practice Address - City:CHESTER SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:19425-3854
Practice Address - Country:US
Practice Address - Phone:732-222-8098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00621600363LF0000X
PASP015929363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily