Provider Demographics
NPI:1871345462
Name:FOUNTAIN, ALIYA IMAN YASMEEN
Entity type:Individual
Prefix:
First Name:ALIYA
Middle Name:IMAN YASMEEN
Last Name:FOUNTAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 WILLIAMSBURG RD APT 42F
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3559
Mailing Address - Country:US
Mailing Address - Phone:919-672-5034
Mailing Address - Fax:
Practice Address - Street 1:1801 WILLIAMSBURG RD APT 42F
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3559
Practice Address - Country:US
Practice Address - Phone:919-672-5034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula