Provider Demographics
NPI:1366218356
Name:BAWAZER, AHLAM
Entity type:Individual
Prefix:
First Name:AHLAM
Middle Name:
Last Name:BAWAZER
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 1:100 S MAIN ST STE 207
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-1479
Mailing Address - Country:US
Mailing Address - Phone:302-659-4490
Mailing Address - Fax:302-659-4495
Practice Address - Street 1:100 S MAIN ST STE 207
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-1479
Practice Address - Country:US
Practice Address - Phone:302-659-4490
Practice Address - Fax:302-659-4495
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0054348163W00000X
DELG-0012413363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse