Provider Demographics
NPI:1588312029
Name:AZZAM, NISRIN
Entity type:Individual
Prefix:MRS
First Name:NISRIN
Middle Name:
Last Name:AZZAM
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 1:19446 PLANTATION ORCHARD LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-3084
Mailing Address - Country:US
Mailing Address - Phone:832-745-6413
Mailing Address - Fax:
Practice Address - Street 1:19446 PLANTATION ORCHARD LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-3084
Practice Address - Country:US
Practice Address - Phone:832-745-6413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility