=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336935899
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ATHENA A SYED NREMT-P
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2025
-----------------------------------------------------
Last Update Date | 04/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1200 N TELEGRAPH RD DEPT 32E
-----------------------------------------------------
City | PONTIAC
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48341-1032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-231-1127
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3146 N ANTIQUE CT
-----------------------------------------------------
City | SANFORD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48657-9154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-488-0131
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 146L00000X
-----------------------------------------------------
Taxonomy Name | Paramedic
-----------------------------------------------------
License Number | 2011264
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------