Provider Demographics
NPI:1669672937
Name:ABUBAKAR, BASIMAH DHAKIRAH (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:BASIMAH
Middle Name:DHAKIRAH
Last Name:ABUBAKAR
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MRS
Other - First Name:BASIMAH
Other - Middle Name:DHAKIRAH
Other - Last Name:MUSADDIQ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1301 WILLOUGHBY LN APT 5324
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-2922
Mailing Address - Country:US
Mailing Address - Phone:682-717-9077
Mailing Address - Fax:
Practice Address - Street 1:1301 WILLOUGHBY LN APT 5324
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-2922
Practice Address - Country:US
Practice Address - Phone:682-717-9077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI226302163WH0500X
WI308212-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163WH0500XNursing Service ProvidersRegistered NurseHemodialysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1669672937Medicaid