Healthcare Provider Details

I. General information

NPI: 1679499438
Provider Name (Legal Business Name): MARYAM OMAR MOALIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 RIVERVIEW DR APT 305
SOUTH SIOUX CITY NE
68776-3545
US

IV. Provider business mailing address

610 13TH ST APT 206
SIOUX CITY IA
51105-1420
US

V. Phone/Fax

Practice location:
  • Phone: 614-615-6723
  • Fax:
Mailing address:
  • Phone: 614-615-6723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: