Provider Demographics
NPI:1659007201
Name:ALI, NASRA
Entity Type:Individual
Prefix:
First Name:NASRA
Middle Name:
Last Name:ALI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5765 178TH ST W # NA
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-5191
Mailing Address - Country:US
Mailing Address - Phone:952-200-7462
Mailing Address - Fax:952-963-0963
Practice Address - Street 1:5765 178TH ST W # NA
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-5191
Practice Address - Country:US
Practice Address - Phone:952-200-7462
Practice Address - Fax:952-963-0963
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health