Provider Demographics
NPI:1124844691
Name:DOULKIDAH, FARAH (RN)
Entity type:Individual
Prefix:
First Name:FARAH
Middle Name:
Last Name:DOULKIDAH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:FARAH
Other - Middle Name:
Other - Last Name:DOULKIDAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:4215 KING BIRD LN
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-0825
Mailing Address - Country:US
Mailing Address - Phone:619-481-9236
Mailing Address - Fax:
Practice Address - Street 1:4215 KING BIRD LN
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-0825
Practice Address - Country:US
Practice Address - Phone:619-481-9236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-29
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH348866163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse