Provider Demographics
NPI:1457412488
Name:LATIF, NAFISA (PA-C, RD, CDE)
Entity Type:Individual
Prefix:MISS
First Name:NAFISA
Middle Name:
Last Name:LATIF
Suffix:
Gender:F
Credentials:PA-C, RD, CDE
Other - Prefix:MISS
Other - First Name:NAFEESUNNISA
Other - Middle Name:
Other - Last Name:FAZULBHOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, RD, CDE
Mailing Address - Street 1:2799 W GRAND BLVD
Mailing Address - Street 2:DEPARTMENT OF NEUROSURGERY
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2608
Mailing Address - Country:US
Mailing Address - Phone:313-874-4689
Mailing Address - Fax:
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:DEPARTMENT OF NEUROSURGERY
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-874-4689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004751363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant