Provider Demographics
NPI:1477380012
Name:NOFAR, ISABELLA
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:
Last Name:NOFAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50102 DRAKES BAY DR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-2544
Mailing Address - Country:US
Mailing Address - Phone:248-210-3615
Mailing Address - Fax:
Practice Address - Street 1:28903 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-0924
Practice Address - Country:US
Practice Address - Phone:248-581-0333
Practice Address - Fax:248-876-9144
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant