Provider Demographics
NPI:1568723336
Name:NIK HASSAN, NIK HALIZA BINTI (MD)
Entity type:Individual
Prefix:
First Name:NIK HALIZA
Middle Name:BINTI
Last Name:NIK HASSAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NIK-HALIZA
Other - Middle Name:
Other - Last Name:NIK-HASSAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:420 DELAWARE ST. S.E.
Mailing Address - Street 2:MMC 295
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0341
Mailing Address - Country:US
Mailing Address - Phone:612-626-6519
Mailing Address - Fax:612-625-7950
Practice Address - Street 1:505 NE 87TH AVE STE 460
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1965
Practice Address - Country:US
Practice Address - Phone:360-514-7771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMD607624612084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty