Provider Demographics
NPI:1013501550
Name:RAZAK, ABDUL A (LPN)
Entity type:Individual
Prefix:MR
First Name:ABDUL
Middle Name:A
Last Name:RAZAK
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 SW 5TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-4675
Mailing Address - Country:US
Mailing Address - Phone:515-771-8545
Mailing Address - Fax:
Practice Address - Street 1:405 SW 5TH ST STE C
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-4675
Practice Address - Country:US
Practice Address - Phone:515-771-8545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAP57023164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse