Provider Demographics
NPI:1447089354
Name:MIRZA, HAJI
Entity type:Individual
Prefix:
First Name:HAJI
Middle Name:
Last Name:MIRZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2708
Mailing Address - Country:US
Mailing Address - Phone:402-610-2533
Mailing Address - Fax:402-805-4066
Practice Address - Street 1:617 SIERRA DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2708
Practice Address - Country:US
Practice Address - Phone:402-610-2594
Practice Address - Fax:402-805-4066
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health