Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 10759A | WY |
Y | 111NI0900X | Internist | 10759A | WY |
N | 207R00000X | Internist | 2015-02392 | NC |
N | 111NI0900X | Internist | 2015-02392 | NC |
N | 207R00000X | Internist | 52854 | CT |
N | 111NI0900X | Internist | 52854 | CT |
N | 207RG0300X | Geriatric Medicine | 2015-02392 | NC |
N | 207RG0300X | Geriatric Medicine | 52854 | CT |
NPI | 1154585271 |
---|---|
Provider Name | Nahida Sultana Khan |
First Address | Gillette, WY 82717-3011 |
Second Address | Gillette, WY 82716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2008 |
Last Update Date | 14/10/2020 |