Provider Demographics
NPI:1700559911
Name:SIROJEVA, ADIBA MAKHAMMATOVNA (APRN)
Entity Type:Individual
Prefix:
First Name:ADIBA
Middle Name:MAKHAMMATOVNA
Last Name:SIROJEVA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4304 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-5517
Mailing Address - Country:US
Mailing Address - Phone:309-948-4279
Mailing Address - Fax:
Practice Address - Street 1:653 52ND AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-7058
Practice Address - Country:US
Practice Address - Phone:319-361-0204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209023796363L00000X
IL041414988163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty