Provider Demographics
NPI:1376166777
Name:BARKADLE, FARDOWSA AHMED
Entity Type:Individual
Prefix:
First Name:FARDOWSA
Middle Name:AHMED
Last Name:BARKADLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 13TH AVE APT B
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-5492
Mailing Address - Country:US
Mailing Address - Phone:970-301-9367
Mailing Address - Fax:
Practice Address - Street 1:1919 13TH AVE APT B
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-5492
Practice Address - Country:US
Practice Address - Phone:970-301-9367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000OtherNO INSURANCE CARD