Healthcare Provider Details

I. General information

NPI: 1639802986
Provider Name (Legal Business Name): IMAN MOHAMED RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 HERITAGE LOOP
LEWIS CENTER OH
43035-9765
US

IV. Provider business mailing address

385 HERITAGE LOOP
LEWIS CENTER OH
43035-9765
US

V. Phone/Fax

Practice location:
  • Phone: 716-930-7327
  • Fax:
Mailing address:
  • Phone: 716-930-7327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0042995
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: