Provider Demographics
NPI:1437573318
Name:KHALIL, MUSTAFA H (NURSING SERVICES)
Entity Type:Individual
Prefix:MR
First Name:MUSTAFA
Middle Name:H
Last Name:KHALIL
Suffix:
Gender:M
Credentials:NURSING SERVICES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3912 BRINKLEY RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-4961
Mailing Address - Country:US
Mailing Address - Phone:301-485-1742
Mailing Address - Fax:
Practice Address - Street 1:3912 BRINKLEY RD
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-4961
Practice Address - Country:US
Practice Address - Phone:301-485-1742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNSA-0392374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide