Provider Demographics
NPI:1912487497
Name:HERSI, AZIZA A
Entity Type:Individual
Prefix:
First Name:AZIZA
Middle Name:A
Last Name:HERSI
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 1:2586 TILLER LN STE 2J2586
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-2265
Mailing Address - Country:US
Mailing Address - Phone:614-285-1742
Mailing Address - Fax:
Practice Address - Street 1:2586 TILLER LN STE 2J
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-2204
Practice Address - Country:US
Practice Address - Phone:614-446-4287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)