Provider Demographics
NPI:1942489026
Name:MIRIAN, RODABEH HOMAYOON (FNP)
Entity Type:Individual
Prefix:MRS
First Name:RODABEH
Middle Name:HOMAYOON
Last Name:MIRIAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:44201 DEQUINDRE RD
Mailing Address - Street 2:BEAUMONT HOSPITAL TROY
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48035-1198
Mailing Address - Country:US
Mailing Address - Phone:248-964-8912
Mailing Address - Fax:
Practice Address - Street 1:44201 DEQUINDRE RD
Practice Address - Street 2:BEAUMONT HOSPITAL TROY
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-1117
Practice Address - Country:US
Practice Address - Phone:248-964-8912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704224314363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily