Provider Demographics
NPI:1427862697
Name:BUALAQ, MARYAM
Entity type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:BUALAQ
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 1:7621 CHERRYWOOD DR APT 14
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-5306
Mailing Address - Country:US
Mailing Address - Phone:407-773-4608
Mailing Address - Fax:
Practice Address - Street 1:808 P ST STE 206
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508-1383
Practice Address - Country:US
Practice Address - Phone:402-937-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion