MEDICARE: ASTRID MAHMOUZIAN BASHMAKIAN

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	174H00000X	Health Educator		MO

General Provider Information

NPI Number	:	1649026337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASTRID MAHMOUZIAN BASHMAKIAN

Provider Business Mailing Address
First Line	:	13005 N FOXGLOVE CT
Second Line	:
City	:	PLATTE CITY
State	:	MO
Zip	:	64079-7935
Country	:	US
Telephone Number	:	720-447-0603
Fax Number	:

Provider Business Practice Location Address
First Line	:	13005 N FOXGLOVE CT
Second Line	:
City	:	PLATTE CITY
State	:	MO
Zip	:	64079-7935
Country	:	US
Telephone Number	:	720-447-0603
Fax Number	:

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

Provider Enumeration Date	:	04/24/2024
Last Update Date	:	04/24/2024

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