Provider Demographics
NPI:1225624778
Name:DIRIE, HALIMO HARBI
Entity Type:Individual
Prefix:MRS
First Name:HALIMO
Middle Name:HARBI
Last Name:DIRIE
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 1:717 28TH ST N # 107
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-3140
Mailing Address - Country:US
Mailing Address - Phone:952-217-6039
Mailing Address - Fax:
Practice Address - Street 1:717 28TH ST N # 107
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-3140
Practice Address - Country:US
Practice Address - Phone:952-217-6039
Practice Address - Fax:952-217-6039
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND62704376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1466336Medicaid