Provider Demographics
NPI:1124264502
Name:AHMED, AZZA H (CPNP)
Entity type:Individual
Prefix:
First Name:AZZA
Middle Name:H
Last Name:AHMED
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 UNIVERSITY STREET
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47907
Mailing Address - Country:US
Mailing Address - Phone:765-404-4040
Mailing Address - Fax:
Practice Address - Street 1:502 N UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47907-2069
Practice Address - Country:US
Practice Address - Phone:765-494-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20082591363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics