Provider Demographics
NPI:1285814319
Name:NISAR, FATIMA (MBBS)
Entity Type:Individual
Prefix:
First Name:FATIMA
Middle Name:
Last Name:NISAR
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:952-883-5375
Mailing Address - Fax:763-587-9130
Practice Address - Street 1:11475 ROBINSON DRIVE NW - MAILSTOP 32600A
Practice Address - Street 2:HEALTHPARTNERS COON RAPIDS CLINIC
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-3746
Practice Address - Country:US
Practice Address - Phone:763-587-9000
Practice Address - Fax:763-587-9130
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program