Provider Demographics
NPI:1407254063
Name:CALHOUN, MIRZANA
Entity Type:Individual
Prefix:
First Name:MIRZANA
Middle Name:
Last Name:CALHOUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIRZANA
Other - Middle Name:
Other - Last Name:IBRAHIMAGIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:411 WESTCHESTER AVE APT 1C
Mailing Address - Street 2:
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-3723
Mailing Address - Country:US
Mailing Address - Phone:914-434-9996
Mailing Address - Fax:
Practice Address - Street 1:411 WESTCHESTER AVE 1-C
Practice Address - Street 2:
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573
Practice Address - Country:US
Practice Address - Phone:914-434-9996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320127-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse