Provider Demographics
NPI:1164305603
Name:ALI, FATIMA (NP)
Entity type:Individual
Prefix:MRS
First Name:FATIMA
Middle Name:
Last Name:ALI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10843 N PEBBLE LN
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-5828
Mailing Address - Country:US
Mailing Address - Phone:262-573-5353
Mailing Address - Fax:
Practice Address - Street 1:10843 N PEBBLE LN
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5828
Practice Address - Country:US
Practice Address - Phone:262-573-5353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17172363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology