Provider Demographics
NPI:1790594554
Name:DAVIS, IMAN (NONE)
Entity type:Individual
Prefix:
First Name:IMAN
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NONE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5215 EDINA INDUSTRIAL BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2926
Mailing Address - Country:US
Mailing Address - Phone:612-594-8405
Mailing Address - Fax:
Practice Address - Street 1:5215 EDINA INDUSTRIAL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55439-2926
Practice Address - Country:US
Practice Address - Phone:612-594-8405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program