Provider Demographics
NPI:1295293983
Name:ALLI, MADIHATU
Entity type:Individual
Prefix:
First Name:MADIHATU
Middle Name:
Last Name:ALLI
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 1:6403 SIERRA BLANCA DR APT 1404
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-1543
Mailing Address - Country:US
Mailing Address - Phone:735-430-7257
Mailing Address - Fax:
Practice Address - Street 1:6403 SIERRA BLANCA DR APT 1404
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-1543
Practice Address - Country:US
Practice Address - Phone:735-430-7257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX957896163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse