Provider Demographics
NPI:1568625481
Name:MIRBAHAEDDIN, ANNA MARIA (CNP)
Entity Type:Individual
Prefix:
First Name:ANNA MARIA
Middle Name:
Last Name:MIRBAHAEDDIN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 S STEMMONS FWY STE 114
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-5335
Mailing Address - Country:US
Mailing Address - Phone:972-420-1475
Mailing Address - Fax:469-671-5437
Practice Address - Street 1:1165 S STEMMONS FWY STE 114
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-5335
Practice Address - Country:US
Practice Address - Phone:972-420-1475
Practice Address - Fax:469-671-5437
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX630847363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics