Provider Demographics
NPI:1629891254
Name:FARAH, NASRA ALI
Entity type:Individual
Prefix:
First Name:NASRA
Middle Name:ALI
Last Name:FARAH
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 1:4736 123RD LN NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-6238
Mailing Address - Country:US
Mailing Address - Phone:612-308-6732
Mailing Address - Fax:
Practice Address - Street 1:4736 123RD LN NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-6238
Practice Address - Country:US
Practice Address - Phone:612-308-6732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver