Provider Demographics
NPI:1609763630
Name:IBRAHIM, NADIA
Entity type:Individual
Prefix:
First Name:NADIA
Middle Name:
Last Name:IBRAHIM
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 1:7525 MITCHELL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-1900
Mailing Address - Country:US
Mailing Address - Phone:952-465-5398
Mailing Address - Fax:
Practice Address - Street 1:7525 MITCHELL RD STE 101
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-1900
Practice Address - Country:US
Practice Address - Phone:952-465-5398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator