Provider Demographics
NPI:1568022366
Name:ANSARI, RUKHSANA (DIRECTOR)
Entity Type:Individual
Prefix:
First Name:RUKHSANA
Middle Name:
Last Name:ANSARI
Suffix:
Gender:F
Credentials:DIRECTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 CHARLION DOWNS LN
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-6487
Mailing Address - Country:US
Mailing Address - Phone:919-621-6546
Mailing Address - Fax:
Practice Address - Street 1:1903 BLUE JAY PT
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-9712
Practice Address - Country:US
Practice Address - Phone:919-621-6546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376K00000X
NCC201826201711374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide