Provider Demographics
NPI:1659095537
Name:HABIBOLAHY, NASRIN
Entity Type:Individual
Prefix:MS
First Name:NASRIN
Middle Name:
Last Name:HABIBOLAHY
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 1:12102 AUDUBON CT
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-2265
Mailing Address - Country:US
Mailing Address - Phone:281-755-3684
Mailing Address - Fax:
Practice Address - Street 1:11611 W AIRPORT BLVD STE 167
Practice Address - Street 2:
Practice Address - City:MEADOWS PLACE
Practice Address - State:TX
Practice Address - Zip Code:77477-3042
Practice Address - Country:US
Practice Address - Phone:281-755-3684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF10220202363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily