Provider Demographics
NPI:1780272294
Name:ALAO, TAWAKALIT F
Entity type:Individual
Prefix:
First Name:TAWAKALIT
Middle Name:F
Last Name:ALAO
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 1:2050 NELSON RD
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-8537
Mailing Address - Country:US
Mailing Address - Phone:815-463-5280
Mailing Address - Fax:
Practice Address - Street 1:2050 NELSON RD
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-8537
Practice Address - Country:US
Practice Address - Phone:815-463-5280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-10
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041329567163W00000X
IL1780272294363LF0000X
IL209022622363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse