Provider Demographics
NPI:1144954959
Name:SAJJAD, MARYAM (APRN)
Entity type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:SAJJAD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12810 SE 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-4307
Mailing Address - Country:US
Mailing Address - Phone:817-296-7814
Mailing Address - Fax:
Practice Address - Street 1:12810 SE 29TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-4307
Practice Address - Country:US
Practice Address - Phone:817-296-7814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-16
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1087840363LP0808X
WAAP61348460363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health