Provider Demographics
NPI:1457182826
Name:ELMI-JELOW, FARTUN
Entity type:Individual
Prefix:
First Name:FARTUN
Middle Name:
Last Name:ELMI-JELOW
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 1:38 6TH AVE S APT 102
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-1634
Mailing Address - Country:US
Mailing Address - Phone:612-735-4314
Mailing Address - Fax:612-545-0914
Practice Address - Street 1:3947 EXCELSIOR BLVD STE 112
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-4779
Practice Address - Country:US
Practice Address - Phone:952-657-5705
Practice Address - Fax:612-545-0914
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician