Provider Demographics
NPI:1215568209
Name:OMAR, FATIMA SEILA
Entity Type:Individual
Prefix:
First Name:FATIMA
Middle Name:SEILA
Last Name:OMAR
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 1:721 46TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-6567
Mailing Address - Country:US
Mailing Address - Phone:507-254-4862
Mailing Address - Fax:
Practice Address - Street 1:721 46TH AVE NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-6567
Practice Address - Country:US
Practice Address - Phone:507-254-4862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health