Provider Demographics
NPI:1811788789
Name:ALI, KHALEEL A
Entity type:Individual
Prefix:
First Name:KHALEEL
Middle Name:A
Last Name:ALI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 G ST APT 4
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2876
Mailing Address - Country:US
Mailing Address - Phone:531-249-4788
Mailing Address - Fax:
Practice Address - Street 1:2011 G ST APT 4
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2876
Practice Address - Country:US
Practice Address - Phone:531-249-4788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide