Basic Information
| Provider Information | |||||||||
| NPI: | 1780213199 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAHMANI | ||||||||
| FirstName: | MARYAM | ||||||||
| MiddleName: | KHALILY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2048 | ||||||||
| Address2: | |||||||||
| City: | NEDERLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 776272048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4097188084 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8595 MEDICAL CENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | PORT ARTHUR | ||||||||
| State: | TX | ||||||||
| PostalCode: | 776402428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4097218600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2020 | ||||||||
| LastUpdateDate: | 04/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP145778 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.