=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932706025
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AHMAD ELZEIN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2020
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3100 E PARK ROW DR # A1
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76010-5102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-450-3835
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3100 E PARK ROW DR # A1
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76010-5102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-450-3835
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WH1000X
-----------------------------------------------------
Taxonomy Name | Hospice Registered Nurse
-----------------------------------------------------
License Number | 884748
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 1036057
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------