Provider Demographics
NPI:1215262621
Name:ALI, NASRA MOHAMUD
Entity type:Individual
Prefix:
First Name:NASRA
Middle Name:MOHAMUD
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 1:8323 CARANO WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43240-6059
Mailing Address - Country:US
Mailing Address - Phone:614-440-2322
Mailing Address - Fax:
Practice Address - Street 1:8323 CARANO WAY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-6059
Practice Address - Country:US
Practice Address - Phone:614-440-2322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-03
Last Update Date:2009-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3651710376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3651710OtherDEPARTMENT OF HEALTH STATE OF OHIO