Provider Demographics
NPI:1154907459
Name:NEZIREVIC, AZIRA
Entity type:Individual
Prefix:
First Name:AZIRA
Middle Name:
Last Name:NEZIREVIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5210 44TH AVE S APT 304
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-4463
Mailing Address - Country:US
Mailing Address - Phone:701-630-9148
Mailing Address - Fax:
Practice Address - Street 1:5210 44TH AVE S APT 304
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-4463
Practice Address - Country:US
Practice Address - Phone:701-630-9148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant