Provider Demographics
NPI:1194591909
Name:ALI, SIFEN M
Entity type:Individual
Prefix:
First Name:SIFEN
Middle Name:M
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 1:12664 CENTRAL AVE NE APT 215
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-4814
Mailing Address - Country:US
Mailing Address - Phone:612-814-1085
Mailing Address - Fax:
Practice Address - Street 1:12664 CENTRAL AVE NE APT 215
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-4814
Practice Address - Country:US
Practice Address - Phone:612-814-1085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1386376600028364ST0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364ST0500XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistTransplantation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN923110645OtherNON EMERGENCY MEDICAL TRANSPORTATION SERVICES