Provider Demographics
NPI:1174265342
Name:IBRAHIM, YASSIR K
Entity Type:Individual
Prefix:MR
First Name:YASSIR
Middle Name:K
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CONLIFFE AVE SW APT 203
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-5792
Mailing Address - Country:US
Mailing Address - Phone:507-491-2300
Mailing Address - Fax:
Practice Address - Street 1:800 CONLIFFE AVE SW APT 203
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5792
Practice Address - Country:US
Practice Address - Phone:507-491-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC0063538OtherHOME CARE