Provider Demographics
NPI:1124431366
Name:MOHAMED, HODA (WHNM)
Entity type:Individual
Prefix:
First Name:HODA
Middle Name:
Last Name:MOHAMED
Suffix:
Gender:F
Credentials:WHNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3830 E VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-6936
Mailing Address - Country:US
Mailing Address - Phone:602-243-7277
Mailing Address - Fax:602-286-0808
Practice Address - Street 1:3830 E VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-6936
Practice Address - Country:US
Practice Address - Phone:602-243-7277
Practice Address - Fax:602-286-0808
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8646363LW0102X
MNCNM1998367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ170823Medicaid