MEDICARE: MRS. BASIMAH DHAKIRAH ABUBAKAR REGISTERED NURSE

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	163WH0500X	Hemodialysis Registered Nurse	226302	WI
2	164W00000X	Licensed Practical Nurse	308212-031	WI

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	:	1669672937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BASIMAH DHAKIRAH ABUBAKAR REGISTERED NURSE

Provider Business Mailing Address
First Line	:	1301 WILLOUGHBY LN APT 5324
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-2922
Country	:	US
Telephone Number	:	682-717-9077
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 WILLOUGHBY LN APT 5324
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-2922
Country	:	US
Telephone Number	:	682-717-9077
Fax Number	:

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

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	03/26/2019

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