Healthcare Provider Details

I. General information

NPI: 1003250069
Provider Name (Legal Business Name): NIZHONI W DENIPAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2213 CHERRY ST
TOLEDO OH
43608-2603
US

IV. Provider business mailing address

150 WASHINGTON AVE STE 201
SANTA FE NM
87501-2038
US

V. Phone/Fax

Practice location:
  • Phone: 419-251-1020
  • Fax:
Mailing address:
  • Phone: 505-477-2200
  • Fax: 505-782-1902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD2018-0901
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35.155761
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: