Provider Demographics
NPI:1609666577
Name:FARES, ESTHER GOBAH
Entity type:Individual
Prefix:
First Name:ESTHER
Middle Name:GOBAH
Last Name:FARES
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 1:312 74TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55444-3000
Mailing Address - Country:US
Mailing Address - Phone:952-688-1026
Mailing Address - Fax:763-326-1354
Practice Address - Street 1:312 74TH AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55444-3000
Practice Address - Country:US
Practice Address - Phone:952-688-1026
Practice Address - Fax:763-326-1354
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN41375376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker