Individual ProviderMaryam RahmanianNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address27 Lake Forgetful Apt 815, Hattiesburg, MS 39402-8288(818) 223-1646PECOS EnrollmentBased on the most recent information from CMS, provider Maryam Rahmanian is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 6 days ago.Profile DetailsProvider ID1851913768Provider TypeIndividualFull NameRahmanian, MaryamCredentialNPGenderFemaleSole ProprietorNoEnumeration Date5/13/2020Last Updated5/13/2020Contact InformationPractice LocationPractice Address27 Lake Forgetful Apt 815, Hattiesburg, MS 39402-8288Phone(818) 223-1646FaxUnlisted FaxMailing LocationMailing Address27 Lake Forgetful Apt 815, Hattiesburg, MS 39402-8288Phone(818) 223-1646FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense903922Mississippi