Healthcare Provider Details

I. General information

NPI: 1730093006
Provider Name (Legal Business Name): ELIZABETH JORDAN ALI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 LINCOLN PARK BLVD
KETTERING OH
45429-6401
US

IV. Provider business mailing address

2873 MACINTOSH LN APT E
MAINEVILLE OH
45039-9348
US

V. Phone/Fax

Practice location:
  • Phone: 937-296-1126
  • Fax:
Mailing address:
  • Phone: 513-659-6592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN.452775
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: