Individual
KANIZ FATEMA ISLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP, PMHNP
Contact information
Practice address
5099 W DOBBINS RD, LAVEEN, AZ 85339-9733
(602) 352-9898
(949) 247-5542
Mailing address
5209 W SIESTA WAY, LAVEEN, AZ 85339-7179
(602) 550-1008
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
AZ5476
AZ
363LF0000X
Family Nurse Practitioner
AZ5476
AZ
363LF0000X
Family Nurse Practitioner
Primary
RN154095
AZ
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AZ5476
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
902324
—
AZ
Enumeration date
04/02/2014
Last updated
05/14/2026
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