Healthcare Provider Details

I. General information

NPI: 1093339020
Provider Name (Legal Business Name): NORA MANAL LAASIRI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4319
US

IV. Provider business mailing address

1500 CHESTNUT ST APT 5C
PHILADELPHIA PA
19102-2744
US

V. Phone/Fax

Practice location:
  • Phone: 267-901-6011
  • Fax:
Mailing address:
  • Phone: 267-901-6011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA064446
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: