Individual
LAYLA ALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
529 S. JEFFERSON ST. SUT #107, GREEN BAY, WI 54301-5430
(612) 296-2798
Mailing address
529 S. JEFFERSON ST. SUT #107, GREEN BAY, WI 54301
(612) 296-2798
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
09/24/2021
Last updated
09/24/2021
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