Healthcare Provider Details

I. General information

NPI: 1023747359
Provider Name (Legal Business Name): ZAKIYA ASAD NOOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 PENN AVE S
BLOOMINGTON MN
55431-2320
US

IV. Provider business mailing address

9333 PENN AVE S
BLOOMINGTON MN
55431-2320
US

V. Phone/Fax

Practice location:
  • Phone: 952-393-8233
  • Fax:
Mailing address:
  • Phone: 952-393-8233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: