Provider Demographics
NPI:1932574365
Name:BASIR, AMINAH
Entity Type:Individual
Prefix:
First Name:AMINAH
Middle Name:
Last Name:BASIR
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 1:3724 TOWER SQUARE DR
Mailing Address - Street 2:UNIT 19
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359-1363
Mailing Address - Country:US
Mailing Address - Phone:248-396-7279
Mailing Address - Fax:
Practice Address - Street 1:3724 TOWER SQUARE DR
Practice Address - Street 2:UNIT 19
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48359-1363
Practice Address - Country:US
Practice Address - Phone:248-396-7279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703029206164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse