1174335152 NPI number — JWANI BAQI AZEEZ SOLE PROPRIETOR

Table of content: JWANI BAQI AZEEZ SOLE PROPRIETOR (NPI 1174335152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174335152 NPI number — JWANI BAQI AZEEZ SOLE PROPRIETOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AZEEZ
Provider First Name:
JWANI
Provider Middle Name:
BAQI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SOLE PROPRIETOR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AZEEZ
Provider Other First Name:
JWANI
Provider Other Middle Name:
BAQI
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
JWANI
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174335152
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8720 PRAIRIE VILLAGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68507-9432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-249-1027
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8720 PRAIRIE VILLAGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68507-9432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-249-1027
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/25/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 376J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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