Provider Demographics
NPI:1649084773
Name:MOHAMMED, AVIN FARHAN
Entity type:Individual
Prefix:
First Name:AVIN
Middle Name:FARHAN
Last Name:MOHAMMED
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5563 SW SIERRA MADRE DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68523-7219
Mailing Address - Country:US
Mailing Address - Phone:402-470-1170
Mailing Address - Fax:
Practice Address - Street 1:2143 POND CIR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-3601
Practice Address - Country:US
Practice Address - Phone:402-470-1170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-07
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3747P1801X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant