Provider Demographics
NPI:1336807882
Name:ISMAIL, NEHRA
Entity Type:Individual
Prefix:
First Name:NEHRA
Middle Name:
Last Name:ISMAIL
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 1:10025 VALLEY VIEW RD STE 110
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3561
Mailing Address - Country:US
Mailing Address - Phone:612-389-0050
Mailing Address - Fax:612-500-4944
Practice Address - Street 1:10025 VALLEY VIEW RD STE 110
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3561
Practice Address - Country:US
Practice Address - Phone:612-389-0050
Practice Address - Fax:612-500-4944
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health