Provider Demographics
NPI:1073304507
Name:MNISI, FEZILE
Entity type:Individual
Prefix:
First Name:FEZILE
Middle Name:
Last Name:MNISI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FEZILE
Other - Middle Name:
Other - Last Name:MNISI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5344 W OHIO ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-1657
Mailing Address - Country:US
Mailing Address - Phone:757-927-3147
Mailing Address - Fax:
Practice Address - Street 1:5344 W OHIO ST UNIT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-1657
Practice Address - Country:US
Practice Address - Phone:757-927-3147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL467696376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide