Healthcare Provider Details

I. General information

NPI: 1609841865
Provider Name (Legal Business Name): BADRUNNISA I HANIF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 W CHARLESTON BLVD 230
LAS VEGAS NV
89102-2351
US

IV. Provider business mailing address

3016 W CHARLESTON BLVD STE 100
LAS VEGAS NV
89102-1973
US

V. Phone/Fax

Practice location:
  • Phone: 702-671-5060
  • Fax: 702-384-6609
Mailing address:
  • Phone: 702-218-0915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number10234
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number10234
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: