Provider Demographics
NPI:1821617416
Name:WEISS, ALI SUE HAINES (MD)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:SUE HAINES
Last Name:WEISS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALI
Other - Middle Name:SUE
Other - Last Name:HAINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7710 MERCY ROAD, SUITE 202
Mailing Address - Street 2:CU DEPARTMENT OF FAMILY MEDICINE
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2353
Mailing Address - Country:US
Mailing Address - Phone:402-280-4318
Mailing Address - Fax:
Practice Address - Street 1:7710 MERCY ROAD, SUITE 202
Practice Address - Street 2:CU DEPARTMENT OF FAMILY MEDICINE
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2353
Practice Address - Country:US
Practice Address - Phone:402-280-4318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE35521207Q00000X, 390200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine