Provider Demographics
NPI:1710447594
Name:BADAVI, ALI (FNP-C)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:BADAVI
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 BAY WILLOW CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-0111
Mailing Address - Country:US
Mailing Address - Phone:919-600-3183
Mailing Address - Fax:
Practice Address - Street 1:321 BAY WILLOW CT
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-0111
Practice Address - Country:US
Practice Address - Phone:919-600-3183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011606363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily