Provider Demographics
NPI:1104368190
Name:FARAH, YASMIN
Entity Type:Individual
Prefix:
First Name:YASMIN
Middle Name:
Last Name:FARAH
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 1:951 LOWRY AVE NE APT 304
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-1913
Mailing Address - Country:US
Mailing Address - Phone:612-229-3455
Mailing Address - Fax:
Practice Address - Street 1:951 LOWRY AVE NE APT 304
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-1913
Practice Address - Country:US
Practice Address - Phone:612-229-3455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL0778950164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse