Provider Demographics
NPI:1326613878
Name:ARIEF, NYIMAS KHAIRUNNISA
Entity Type:Individual
Prefix:
First Name:NYIMAS
Middle Name:KHAIRUNNISA
Last Name:ARIEF
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 1:3337 FREMONT AVE S APT 4
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-3529
Mailing Address - Country:US
Mailing Address - Phone:832-607-2130
Mailing Address - Fax:
Practice Address - Street 1:3337 FREMONT AVE S APT 4
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-3529
Practice Address - Country:US
Practice Address - Phone:832-607-2130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst