MEDICARE: NASRA MOHAMUD ALI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	3651710	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3651710	OTHER	OH	DEPARTMENT OF HEALTH STATE OF OHIO

General Provider Information

NPI Number	:	1215262621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NASRA MOHAMUD ALI

Provider Business Mailing Address
First Line	:	8323 CARANO WAY
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43240-6059
Country	:	US
Telephone Number	:	614-440-2322
Fax Number	:

Provider Business Practice Location Address
First Line	:	8323 CARANO WAY
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43240-6059
Country	:	US
Telephone Number	:	614-440-2322
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2009
Last Update Date	:	10/03/2009

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Directions to “ NASRA MOHAMUD ALI ” Practice Location

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