Provider Demographics
NPI:1619623436
Name:MAHMOOD, NABEEHA NASEER
Entity Type:Individual
Prefix:
First Name:NABEEHA
Middle Name:NASEER
Last Name:MAHMOOD
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 1:1717 N. HIGH ST.
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906-4529
Mailing Address - Country:US
Mailing Address - Phone:517-372-4700
Mailing Address - Fax:517-372-3314
Practice Address - Street 1:1717 N. HIGH ST.
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-4529
Practice Address - Country:US
Practice Address - Phone:517-372-4700
Practice Address - Fax:517-372-3314
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1700901964390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program