Provider Demographics
NPI:1669190591
Name:IBRAHIM, RUMANA MOHAMMED SALH
Entity type:Individual
Prefix:MRS
First Name:RUMANA
Middle Name:MOHAMMED SALH
Last Name:IBRAHIM
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:RUMANA
Other - Middle Name:MOHAMMED SALIH
Other - Last Name:IBRAHIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:964 SKINNER DR
Mailing Address - Street 2:964
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610
Mailing Address - Country:US
Mailing Address - Phone:919-349-4149
Mailing Address - Fax:
Practice Address - Street 1:964 SKINNER DR
Practice Address - Street 2:964
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610
Practice Address - Country:US
Practice Address - Phone:919-349-4149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver