Provider Demographics
NPI:1679145122
Name:ALI, NABIHA ABUBAKAR
Entity Type:Individual
Prefix:
First Name:NABIHA
Middle Name:ABUBAKAR
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 1:5701 KENTUCKY AVE N STE 201
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55428-3394
Mailing Address - Country:US
Mailing Address - Phone:507-573-1039
Mailing Address - Fax:
Practice Address - Street 1:5701 KENTUCKY AVE N STE 201
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55428-3394
Practice Address - Country:US
Practice Address - Phone:507-573-1039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical