Provider Demographics
NPI:1356055164
Name:KOROW, MOHAMUD ALI (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:MOHAMUD
Middle Name:ALI
Last Name:KOROW
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:9333 PENN AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-2320
Mailing Address - Country:US
Mailing Address - Phone:952-405-9937
Mailing Address - Fax:952-303-4837
Practice Address - Street 1:9333 PENN AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-2320
Practice Address - Country:US
Practice Address - Phone:952-405-9937
Practice Address - Fax:952-303-4837
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN9817363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily