Healthcare Provider Details

I. General information

NPI: 1568323111
Provider Name (Legal Business Name): ABDUL NABI BIN NUR ALAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2025
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2126 14TH ST
GREELEY CO
80631-4559
US

IV. Provider business mailing address

2126 14TH ST
GREELEY CO
80631-4559
US

V. Phone/Fax

Practice location:
  • Phone: 970-518-0886
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number7756536
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number2026173876
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: