Provider Demographics
NPI:1083275218
Name:BARRE, MARIAM ALI
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:ALI
Last Name:BARRE
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 1:7120 13TH AVE S
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-3347
Mailing Address - Country:US
Mailing Address - Phone:612-501-8333
Mailing Address - Fax:952-222-5418
Practice Address - Street 1:7120 13TH AVE S
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-3347
Practice Address - Country:US
Practice Address - Phone:206-234-4927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNNONEOtherMINNESOTA STATE