Provider Demographics
NPI:1316562432
Name:NASRALLAH, LAYA (NP)
Entity Type:Individual
Prefix:
First Name:LAYA
Middle Name:
Last Name:NASRALLAH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25909 WARRINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-2913
Mailing Address - Country:US
Mailing Address - Phone:313-247-4596
Mailing Address - Fax:
Practice Address - Street 1:5728 SCHAEFER RD STE 103
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2287
Practice Address - Country:US
Practice Address - Phone:313-581-8080
Practice Address - Fax:313-581-8383
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704288912363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health