Provider Demographics
NPI:1477533610
Name:LATEEF, MARYAM H (MHNP)
Entity Type:Individual
Prefix:
First Name:MARYAM
Middle Name:H
Last Name:LATEEF
Suffix:
Gender:F
Credentials:MHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7219 S 15TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-6930
Mailing Address - Country:US
Mailing Address - Phone:602-403-5050
Mailing Address - Fax:623-777-0820
Practice Address - Street 1:8613 S 7TH DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-8311
Practice Address - Country:US
Practice Address - Phone:480-835-2371
Practice Address - Fax:623-847-4047
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP 1782363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ702911Medicaid
AZZ76748Medicare UPIN