Healthcare Provider Details

I. General information

NPI: 1073418232
Provider Name (Legal Business Name): ALAA MUHAMMAD KHATIB NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W6018 RYFORD ST
MENASHA WI
54952-8400
US

IV. Provider business mailing address

W6018 RYFORD ST
MENASHA WI
54952-8400
US

V. Phone/Fax

Practice location:
  • Phone: 920-224-3198
  • Fax:
Mailing address:
  • Phone: 920-224-3198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19239
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: