Provider Demographics
NPI:1508476045
Name:ABUSIM, ANFAL A
Entity Type:Individual
Prefix:
First Name:ANFAL
Middle Name:A
Last Name:ABUSIM
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 1:2190 HARSHMAN RD APT 12
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-6611
Mailing Address - Country:US
Mailing Address - Phone:937-409-9923
Mailing Address - Fax:
Practice Address - Street 1:2190 HARSHMAN RD APT 12
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45424-6611
Practice Address - Country:US
Practice Address - Phone:937-409-9923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No171R00000XOther Service ProvidersInterpreter
No372500000XNursing Service Related ProvidersChore Provider
No385H00000XRespite Care FacilityRespite Care