Provider Demographics
NPI:1992782007
Name:MAHAMA, NURUDEEN DINTIE (NP)
Entity type:Individual
Prefix:
First Name:NURUDEEN
Middle Name:DINTIE
Last Name:MAHAMA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 S AVENUE A
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7170
Mailing Address - Country:US
Mailing Address - Phone:928-344-2000
Mailing Address - Fax:
Practice Address - Street 1:2400 S AVENUE A
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7127
Practice Address - Country:US
Practice Address - Phone:928-336-3213
Practice Address - Fax:928-336-3215
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2025-01-02
Deactivation Date:2006-03-19
Deactivation Code:
Reactivation Date:2007-04-13
Provider Licenses
StateLicense IDTaxonomies
OHNP07335363LA2200X
OHRN281904163WG0600X
AZAP5554363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2407292Medicaid
MM4624246OtherDEA
OH2407292Medicaid
P89509Medicare UPIN