Provider Demographics
NPI:1093515470
Name:HASSAN, ALI JIBRIL
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:JIBRIL
Last Name:HASSAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 N 16TH ST APT 218
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-4450
Mailing Address - Country:US
Mailing Address - Phone:531-361-8144
Mailing Address - Fax:
Practice Address - Street 1:1015 N 16TH ST APT 218
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-4450
Practice Address - Country:US
Practice Address - Phone:531-361-8144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-15
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE374U00000X, 3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No374U00000XNursing Service Related ProvidersHome Health Aide