Provider Demographics
NPI:1083172183
Name:FARAH, BISHARO HASSAN (CHW)
Entity Type:Individual
Prefix:
First Name:BISHARO
Middle Name:HASSAN
Last Name:FARAH
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 731
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-0731
Mailing Address - Country:US
Mailing Address - Phone:507-323-8100
Mailing Address - Fax:507-322-4003
Practice Address - Street 1:223 CENTRAL AVE N
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5212
Practice Address - Country:US
Practice Address - Phone:507-323-8100
Practice Address - Fax:507-322-4003
Is Sole Proprietor?:No
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker