Healthcare Provider Details

I. General information

NPI: 1790621779
Provider Name (Legal Business Name): NUR MEDTRANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1667 LENWOOD AVE APT 1
GREEN BAY WI
54303-1283
US

IV. Provider business mailing address

1667 LENWOOD AVE APT 1
GREEN BAY WI
54303-1283
US

V. Phone/Fax

Practice location:
  • Phone: 920-662-3304
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. ABADIR M ISMAIL
Title or Position: CEO
Credential:
Phone: 920-662-3304