Provider Demographics
NPI:1346886306
Name:REDZEPI, AJLA (CPNP)
Entity Type:Individual
Prefix:
First Name:AJLA
Middle Name:
Last Name:REDZEPI
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY PEDIATRICIANS
Mailing Address - Street 2:4201 ST. ANTOINE - UHC 5D MAILBOX 226
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2153
Mailing Address - Country:US
Mailing Address - Phone:313-745-4405
Mailing Address - Fax:313-966-0665
Practice Address - Street 1:CHILDREN'S HOPSITAL OF MI
Practice Address - Street 2:3901 BEAUBIEN - 5TH FL - CARL'S BUILDING
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2119
Practice Address - Country:US
Practice Address - Phone:313-745-5862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704295520363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics