Provider Demographics
NPI:1952003865
Name:NAOOM, JAY EMAD (DNP)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:EMAD
Last Name:NAOOM
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4508 S TENNIS LN APT 203
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-3119
Mailing Address - Country:US
Mailing Address - Phone:605-838-8999
Mailing Address - Fax:
Practice Address - Street 1:1216 RYANS RD
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-1780
Practice Address - Country:US
Practice Address - Phone:507-372-2921
Practice Address - Fax:507-372-6523
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN10038363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily