Provider Demographics
NPI:1497345961
Name:KHALIF, NIMCO
Entity Type:Individual
Prefix:
First Name:NIMCO
Middle Name:
Last Name:KHALIF
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 1:1082 GALTIER ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-5105
Mailing Address - Country:US
Mailing Address - Phone:612-990-9060
Mailing Address - Fax:
Practice Address - Street 1:1082 GALTIER ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117-5105
Practice Address - Country:US
Practice Address - Phone:612-990-9060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician