Provider Demographics
NPI:1740050673
Name:ALI, SHAZIANA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:SHAZIANA
Middle Name:
Last Name:ALI
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7223 KALLIE KAY LN
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-4317
Mailing Address - Country:US
Mailing Address - Phone:916-284-8823
Mailing Address - Fax:
Practice Address - Street 1:7223 KALLIE KAY LN
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-4317
Practice Address - Country:US
Practice Address - Phone:916-284-8823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95226472163W00000X
CA95028368363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse