Provider Demographics
NPI:1740633973
Name:JOORABCHI, NISA
Entity type:Individual
Prefix:
First Name:NISA
Middle Name:
Last Name:JOORABCHI
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 1:2785 AYERSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0804
Mailing Address - Country:US
Mailing Address - Phone:248-396-5239
Mailing Address - Fax:
Practice Address - Street 1:1241 E DYER RD
Practice Address - Street 2:SUITE 145
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5611
Practice Address - Country:US
Practice Address - Phone:949-449-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704269419363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care