Provider Demographics
NPI:1679342596
Name:JANAW, IFRAH MOHAMED
Entity Type:Individual
Prefix:
First Name:IFRAH
Middle Name:MOHAMED
Last Name:JANAW
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 1:13215 ALABAMA AVE S
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-2490
Mailing Address - Country:US
Mailing Address - Phone:507-341-5700
Mailing Address - Fax:
Practice Address - Street 1:100 RIVER RIDGE CT STE 1
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-1613
Practice Address - Country:US
Practice Address - Phone:612-636-8746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist