Provider Demographics
NPI:1609463967
Name:ABDUL-BASIR, MARYUM ATYIA
Entity Type:Individual
Prefix:MISS
First Name:MARYUM
Middle Name:ATYIA
Last Name:ABDUL-BASIR
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 1:4001 BARRINGER LN APT 2226
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1160
Mailing Address - Country:US
Mailing Address - Phone:804-647-4770
Mailing Address - Fax:
Practice Address - Street 1:4001 BARRINGER LN APT 2226
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-1160
Practice Address - Country:US
Practice Address - Phone:804-647-4770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001288273163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse