Provider Demographics
NPI:1700554706
Name:ALI, SUHA Y (RN)
Entity Type:Individual
Prefix:MS
First Name:SUHA
Middle Name:Y
Last Name:ALI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 SOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2921
Mailing Address - Country:US
Mailing Address - Phone:708-676-0288
Mailing Address - Fax:
Practice Address - Street 1:327 SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2921
Practice Address - Country:US
Practice Address - Phone:708-676-0288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.467231163WC0200X, 163WG0000X, 163WS0121X, 163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery