Provider Demographics
NPI:1831325760
Name:ALI, KHADIJJA SABIAH
Entity type:Individual
Prefix:MS
First Name:KHADIJJA
Middle Name:SABIAH
Last Name:ALI
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 1:6611 N BOURBON ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-5151
Mailing Address - Country:US
Mailing Address - Phone:414-975-2376
Mailing Address - Fax:
Practice Address - Street 1:6611 N BOURBON ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-5151
Practice Address - Country:US
Practice Address - Phone:414-975-2376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI302847-031164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse