Provider Demographics
NPI:1528415452
Name:IMAN, MUNA
Entity Type:Individual
Prefix:
First Name:MUNA
Middle Name:
Last Name:IMAN
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 1:2510 41ST AVE S APT 103
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-8942
Mailing Address - Country:US
Mailing Address - Phone:320-310-7276
Mailing Address - Fax:
Practice Address - Street 1:2510 41ST AVE S APT 103
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-8942
Practice Address - Country:US
Practice Address - Phone:320-310-7276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide