Provider Demographics
NPI:1871075754
Name:QURESHI, ZAMARA W (PA)
Entity type:Individual
Prefix:
First Name:ZAMARA
Middle Name:W
Last Name:QURESHI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 28TH AVENUE DR
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-5536
Mailing Address - Country:US
Mailing Address - Phone:309-281-6000
Mailing Address - Fax:
Practice Address - Street 1:3900 28TH AVENUE DR
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-5536
Practice Address - Country:US
Practice Address - Phone:309-281-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO220060604Medicaid