Provider Demographics
NPI:1548999600
Name:OUAHIDI, IMANE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:IMANE
Middle Name:
Last Name:OUAHIDI
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W SQUANTUM ST STE 8
Mailing Address - Street 2:
Mailing Address - City:NORTH QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-2158
Mailing Address - Country:US
Mailing Address - Phone:617-370-3000
Mailing Address - Fax:
Practice Address - Street 1:110 W SQUANTUM ST
Practice Address - Street 2:
Practice Address - City:NORTH QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-2122
Practice Address - Country:US
Practice Address - Phone:617-376-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2317910363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily