Provider Demographics
NPI:1790316891
Name:KHAKIMOVA, DILAFRUZ (RN)
Entity Type:Individual
Prefix:
First Name:DILAFRUZ
Middle Name:
Last Name:KHAKIMOVA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 LINK LN
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-6149
Mailing Address - Country:US
Mailing Address - Phone:347-666-9779
Mailing Address - Fax:
Practice Address - Street 1:48 LINK LN
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-6149
Practice Address - Country:US
Practice Address - Phone:347-666-9779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY738439163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty