Provider Demographics
NPI:1497485031
Name:ALI, HADIA (PA)
Entity Type:Individual
Prefix:
First Name:HADIA
Middle Name:
Last Name:ALI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6477 W ANNIE LEE WAY
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-4600
Mailing Address - Country:US
Mailing Address - Phone:850-345-5827
Mailing Address - Fax:
Practice Address - Street 1:6477 W ANNIE LEE WAY
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84081-4600
Practice Address - Country:US
Practice Address - Phone:850-345-5827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2022-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant