Healthcare Provider Details

I. General information

NPI: 1407735418
Provider Name (Legal Business Name): YABEREMI EMMANUELLA ALIU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 09/02/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 E LIBERTY ST UNIT 310
LOUISVILLE KY
40202-1199
US

IV. Provider business mailing address

533 E LIBERTY ST UNIT 310
LOUISVILLE KY
40202-1199
US

V. Phone/Fax

Practice location:
  • Phone: 317-654-6160
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number4010713
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: