Provider Demographics
NPI:1417738923
Name:NABAKOOZA, FARIDAH
Entity Type:Individual
Prefix:
First Name:FARIDAH
Middle Name:
Last Name:NABAKOOZA
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 1:200 MARKET ST APT A17
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1886
Mailing Address - Country:US
Mailing Address - Phone:978-483-9982
Mailing Address - Fax:
Practice Address - Street 1:17 LINDALL ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2259
Practice Address - Country:US
Practice Address - Phone:978-483-9982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2318447163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health