Provider Demographics
NPI:1558246090
Name:NEV BAHAR, REEM HEAVEN (CCMA)
Entity type:Individual
Prefix:MS
First Name:REEM
Middle Name:HEAVEN
Last Name:NEV BAHAR
Suffix:
Gender:F
Credentials:CCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 S 300 W APT 412
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-4124
Mailing Address - Country:US
Mailing Address - Phone:801-634-0581
Mailing Address - Fax:
Practice Address - Street 1:1512 S 300 W APT 412
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-4124
Practice Address - Country:US
Practice Address - Phone:801-634-0581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTSL-8826246RP1900X
UT247200000X, 374U00000X, 376K00000X
ZZ6040-35206637363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide