Provider Demographics
NPI:1295254134
Name:TOMA, AHLAM MATTI (FNP-C)
Entity type:Individual
Prefix:
First Name:AHLAM
Middle Name:MATTI
Last Name:TOMA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7742 SCHAEFER RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1159
Mailing Address - Country:US
Mailing Address - Phone:313-429-3195
Mailing Address - Fax:313-429-3198
Practice Address - Street 1:7742 SCHAEFER RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1159
Practice Address - Country:US
Practice Address - Phone:313-429-3195
Practice Address - Fax:313-429-3198
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704311900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty