Provider Demographics
NPI:1538421094
Name:ABUL-HUSN, NINA KELLIE LATEEFEE (MD, MSPH)
Entity type:Individual
Prefix:DR
First Name:NINA
Middle Name:KELLIE LATEEFEE
Last Name:ABUL-HUSN
Suffix:
Gender:F
Credentials:MD, MSPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 12TH AVE RD STE B
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-6100
Mailing Address - Country:US
Mailing Address - Phone:120-844-2009
Mailing Address - Fax:208-375-2217
Practice Address - Street 1:2785 BANNOCK HWY
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-3607
Practice Address - Country:US
Practice Address - Phone:208-904-2654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PHYS-COM-LIC-147207QA0401X, 208D00000X
IDM-13784208D00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice