Provider Demographics
NPI:1154952356
Name:ROTELL, HANIEH SHIRGIR (FNP-C)
Entity type:Individual
Prefix:MS
First Name:HANIEH
Middle Name:SHIRGIR
Last Name:ROTELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 DALWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6642
Mailing Address - Country:US
Mailing Address - Phone:678-549-2572
Mailing Address - Fax:
Practice Address - Street 1:3905 BROOKSIDE PKWY STE 203
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-4425
Practice Address - Country:US
Practice Address - Phone:678-668-4688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN216187163W00000X, 363LF0000X, 207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily