Provider Demographics
NPI:1265251854
Name:NASSAR, ARIANNA FAHMIEH (PA)
Entity type:Individual
Prefix:
First Name:ARIANNA
Middle Name:FAHMIEH
Last Name:NASSAR
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:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-6476
Mailing Address - Fax:336-716-0194
Practice Address - Street 1:111 HANESTOWN CT STE 351
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1749
Practice Address - Country:US
Practice Address - Phone:336-716-6476
Practice Address - Fax:336-716-0194
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-14721363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant