Provider Demographics
NPI:1982261350
Name:AL-NAZER, FAWAZ (PHD)
Entity Type:Individual
Prefix:DR
First Name:FAWAZ
Middle Name:
Last Name:AL-NAZER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15121 BEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-2497
Mailing Address - Country:US
Mailing Address - Phone:402-800-0560
Mailing Address - Fax:402-625-0718
Practice Address - Street 1:15121 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-2497
Practice Address - Country:US
Practice Address - Phone:402-800-0560
Practice Address - Fax:402-625-0718
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4086921253Z00000X, 251E00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No374U00000XNursing Service Related ProvidersHome Health Aide