Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | BH5555 | AZ |
NPI | 1548736259 |
---|---|
Provider Name | Nurein Migyimah Shaibu |
First Address | Chandler, AZ 85224-8663 |
Second Address | Chandler, AZ 85224-8663 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2018 |
Last Update Date | 19/10/2018 |