Provider Demographics
NPI:1043855364
Name:SAISSI HASSANI, WAFAA
Entity type:Individual
Prefix:
First Name:WAFAA
Middle Name:
Last Name:SAISSI HASSANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 N WHIPPLE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3878
Mailing Address - Country:US
Mailing Address - Phone:773-630-1314
Mailing Address - Fax:
Practice Address - Street 1:1908 N WHIPPLE ST APT 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-3878
Practice Address - Country:US
Practice Address - Phone:773-630-1314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-11
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)