Provider Demographics
NPI:1760101158
Name:LEFAIRE, ZEINABOU (PA)
Entity Type:Individual
Prefix:
First Name:ZEINABOU
Middle Name:
Last Name:LEFAIRE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ZEINABOU
Other - Middle Name:
Other - Last Name:MAHAMADOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1906 MIKE DR
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-7975
Mailing Address - Country:US
Mailing Address - Phone:254-319-4798
Mailing Address - Fax:
Practice Address - Street 1:3600 N GARFIELD ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-6329
Practice Address - Country:US
Practice Address - Phone:432-620-1120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program