Healthcare Provider Details

I. General information

NPI: 1508476045
Provider Name (Legal Business Name): ANFAL A ABUSIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2190 HARSHMAN RD APT 12
DAYTON OH
45424-6611
US

IV. Provider business mailing address

2190 HARSHMAN RD APT 12
DAYTON OH
45424-6611
US

V. Phone/Fax

Practice location:
  • Phone: 937-409-9923
  • Fax:
Mailing address:
  • Phone: 937-409-9923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: