Provider Demographics
NPI:1619274651
Name:NUR, HABIBA ALI (CASE MANGER)
Entity Type:Individual
Prefix:
First Name:HABIBA
Middle Name:ALI
Last Name:NUR
Suffix:
Gender:F
Credentials:CASE MANGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1074 W 4175 S
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84405-2615
Mailing Address - Country:US
Mailing Address - Phone:801-467-6060
Mailing Address - Fax:801-486-3007
Practice Address - Street 1:155 S 300 W
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-1217
Practice Address - Country:US
Practice Address - Phone:801-467-6060
Practice Address - Fax:801-486-3007
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator