Provider Demographics
NPI:1821616764
Name:AYOUR, NOUSSAIBA (PA-C)
Entity type:Individual
Prefix:
First Name:NOUSSAIBA
Middle Name:
Last Name:AYOUR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9700 WATERSTONE PL APT 220
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-7505
Mailing Address - Country:US
Mailing Address - Phone:952-607-0217
Mailing Address - Fax:800-398-8041
Practice Address - Street 1:9700 WATERSTONE PL APT 220
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-7505
Practice Address - Country:US
Practice Address - Phone:952-607-0217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
MN14582363AM0700X
WI8197-23363AM0700X
FLTPPA755363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1649035213Medicaid