Provider Demographics
NPI:1477053338
Name:LAH, FATIMA AYODELE (FNP)
Entity Type:Individual
Prefix:MS
First Name:FATIMA
Middle Name:AYODELE
Last Name:LAH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2946 E COUNTRY SHADOWS ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-9048
Mailing Address - Country:US
Mailing Address - Phone:832-455-6678
Mailing Address - Fax:
Practice Address - Street 1:2946 E COUNTRY SHADOWS ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-9048
Practice Address - Country:US
Practice Address - Phone:832-455-6678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-17
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ242454363LF0000X
TX883859163W00000X
TXAP144807363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse