Provider Demographics
NPI:1558801522
Name:NAIR, AJITHA (MSN/FNP)
Entity Type:Individual
Prefix:
First Name:AJITHA
Middle Name:
Last Name:NAIR
Suffix:
Gender:F
Credentials:MSN/FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4038 E BRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-0708
Mailing Address - Country:US
Mailing Address - Phone:480-577-7208
Mailing Address - Fax:
Practice Address - Street 1:4038 E BRUCE AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-0708
Practice Address - Country:US
Practice Address - Phone:480-577-7208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN143649363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily