Provider Demographics
NPI:1215613930
Name:MOHAMED, AMETIRAHMAAN (NP)
Entity type:Individual
Prefix:
First Name:AMETIRAHMAAN
Middle Name:
Last Name:MOHAMED
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AMET
Other - Middle Name:
Other - Last Name:MOHAMED
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:5145 KENDAL ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3155
Mailing Address - Country:US
Mailing Address - Phone:313-899-8575
Mailing Address - Fax:
Practice Address - Street 1:5145 KENDAL ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3155
Practice Address - Country:US
Practice Address - Phone:313-899-8575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAG02230025363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health