Provider Demographics
NPI:1780190108
Name:ABDUKKALIQ, DAHAB (FNP)
Entity Type:Individual
Prefix:
First Name:DAHAB
Middle Name:
Last Name:ABDUKKALIQ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2473 E KEMPTON RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-2358
Mailing Address - Country:US
Mailing Address - Phone:480-707-2142
Mailing Address - Fax:
Practice Address - Street 1:2473 E KEMPTON RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-2358
Practice Address - Country:US
Practice Address - Phone:480-707-2142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10831363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily