Provider Demographics
NPI:1831783695
Name:ABDALLAH, FATIMA (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:FATIMA
Middle Name:
Last Name:ABDALLAH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10140 VERNOR HWY
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1515
Mailing Address - Country:US
Mailing Address - Phone:313-438-6059
Mailing Address - Fax:
Practice Address - Street 1:10140 VERNOR HWY
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48120-1515
Practice Address - Country:US
Practice Address - Phone:313-438-6059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704301119363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily