Provider Demographics
NPI:1619549482
Name:ALY-ABDEL-LATIF, AHMED H (RN)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:H
Last Name:ALY-ABDEL-LATIF
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15735 VAN AVE
Mailing Address - Street 2:
Mailing Address - City:FRASER
Mailing Address - State:MI
Mailing Address - Zip Code:48026-2710
Mailing Address - Country:US
Mailing Address - Phone:313-434-6667
Mailing Address - Fax:
Practice Address - Street 1:15735 VAN AVE
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026-2710
Practice Address - Country:US
Practice Address - Phone:313-434-6667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704293356163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse