MEDICARE: MRS. NALEENEE TRADER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3104A0625X	Assisted Living Facility (Mental Illness)	AL10631	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376948729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NALEENEE TRADER

Provider Business Mailing Address
First Line	:	3091 NW 43RD ST
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33309-4310
Country	:	US
Telephone Number	:	954-777-5167
Fax Number	:	954-733-1167

Provider Business Practice Location Address
First Line	:	3091 NW 43RD ST
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33309-4310
Country	:	US
Telephone Number	:	954-777-5167
Fax Number	:	954-733-1167

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2014
Last Update Date	:	10/28/2014

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