Provider Demographics
NPI:1548846363
Name:YAQOOB, NADIA (RN)
Entity type:Individual
Prefix:
First Name:NADIA
Middle Name:
Last Name:YAQOOB
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MCCHESNEY AVE EXT APT 19-12
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-8798
Mailing Address - Country:US
Mailing Address - Phone:518-238-8622
Mailing Address - Fax:
Practice Address - Street 1:400 MCCHESNEY AVE EXT APT 19-12
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-8798
Practice Address - Country:US
Practice Address - Phone:518-238-8622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY785299163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care