Provider Demographics
NPI:1114014883
Name:ABDOWAISE, NEDIRA M (PA)
Entity type:Individual
Prefix:
First Name:NEDIRA
Middle Name:M
Last Name:ABDOWAISE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 FM 1960 WEST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090
Mailing Address - Country:US
Mailing Address - Phone:281-440-2543
Mailing Address - Fax:409-772-0885
Practice Address - Street 1:710 FM 1960 WEST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090
Practice Address - Country:US
Practice Address - Phone:281-440-2543
Practice Address - Fax:409-772-0885
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03124207P00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP47955Medicare UPIN
TX8689N5Medicare ID - Type Unspecified