Provider Demographics
NPI:1396140380
Name:NASERI, ZIBA
Entity type:Individual
Prefix:
First Name:ZIBA
Middle Name:
Last Name:NASERI
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 1:3420 MAPLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OH
Mailing Address - Zip Code:44425-8720
Mailing Address - Country:US
Mailing Address - Phone:330-534-5893
Mailing Address - Fax:
Practice Address - Street 1:2500 HIGHLAND RD STE 101
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-4602
Practice Address - Country:US
Practice Address - Phone:724-588-1082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-03
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA057332363A00000X
OH004169363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant