Provider Demographics
NPI:1447492152
Name:HASAN, NAEEMAH AKILAH (RN, BSN, CD)
Entity type:Individual
Prefix:
First Name:NAEEMAH
Middle Name:AKILAH
Last Name:HASAN
Suffix:
Gender:F
Credentials:RN, BSN, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106006 N 3690 RD
Mailing Address - Street 2:
Mailing Address - City:BOLEY
Mailing Address - State:OK
Mailing Address - Zip Code:74829-2920
Mailing Address - Country:US
Mailing Address - Phone:918-667-3762
Mailing Address - Fax:
Practice Address - Street 1:106006 N 3690 RD
Practice Address - Street 2:
Practice Address - City:BOLEY
Practice Address - State:OK
Practice Address - Zip Code:74829-2920
Practice Address - Country:US
Practice Address - Phone:918-667-3762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-26
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
OK090271163WP1700X
OK90271163W00000X
CARN95061394163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No374J00000XNursing Service Related ProvidersDoula
No163WP1700XNursing Service ProvidersRegistered NursePerinatal
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200125800AMedicaid