Basic Information
| Provider Information | |||||||||
| NPI: | 1265530877 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KYAZIMOVA | ||||||||
| FirstName: | MARINA | ||||||||
| MiddleName: | SEMENOVNA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3803 N ELM ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274552593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365407067 | ||||||||
| FaxNumber: | 3365406756 | ||||||||
| Practice Location | |||||||||
| Address1: | 3803 N ELM ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274552593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365407067 | ||||||||
| FaxNumber: | 8888823919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 11/03/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 103425 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.