Provider Demographics
NPI:1063881274
Name:AMEH, MARY HABIBA (ARNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:HABIBA
Last Name:AMEH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3900 S ZINTEL WAY FL 2
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-5092
Mailing Address - Country:US
Mailing Address - Phone:509-942-3125
Mailing Address - Fax:509-585-8173
Practice Address - Street 1:3900 S ZINTEL WAY FL 2
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99337-5092
Practice Address - Country:US
Practice Address - Phone:509-942-3125
Practice Address - Fax:509-585-8173
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007887363LP0808X, 363LF0000X
WAAP61433603363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1063881274Medicaid