Healthcare Provider Details

I. General information

NPI: 1851921431
Provider Name (Legal Business Name): NASIMA OMAR SZCZESNY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NASIMA OMAR PA-C

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 JOLLY RD STE 240
OKEMOS MI
48864-3681
US

IV. Provider business mailing address

2525 JOLLY RD STE 240
OKEMOS MI
48864-3681
US

V. Phone/Fax

Practice location:
  • Phone: 989-729-4304
  • Fax:
Mailing address:
  • Phone: 989-729-4304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: