Basic Information
| Provider Information | |||||||||
| NPI: | 1598393506 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NASEEM | ||||||||
| FirstName: | KHADIJA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3200 MACCORKLE AVE SE | ||||||||
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| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253041227 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | ROBERT C. BIRD CLINICAL TRAINING CENTER | ||||||||
| Address2: | 3200 MACCORKLE AVENUE SOUTHEAST | ||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253041208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043885590 | ||||||||
| FaxNumber: | 3043888238 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2020 | ||||||||
| LastUpdateDate: | 03/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.