Provider Demographics
NPI:1326882309
Name:GHIZLANE, KHAWLA
Entity type:Individual
Prefix:
First Name:KHAWLA
Middle Name:
Last Name:GHIZLANE
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 1:193 WASHINGTON LOOP
Mailing Address - Street 2:DYESS AFB
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79607
Mailing Address - Country:US
Mailing Address - Phone:302-690-7487
Mailing Address - Fax:
Practice Address - Street 1:193 WASHINGTON LOOP
Practice Address - Street 2:DYESS AFB
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79607
Practice Address - Country:US
Practice Address - Phone:302-690-7487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14894374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX994619607OtherBIRTH AND POSTPARTUM DOULA