Healthcare Provider Details

I. General information

NPI: 1770447898
Provider Name (Legal Business Name): MARIAM FARAH PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 NORMANDALE LAKE BLVD STE 350
BLOOMINGTON MN
55437-3805
US

IV. Provider business mailing address

8500 NORMANDALE LAKE BLVD STE 350
BLOOMINGTON MN
55437-3805
US

V. Phone/Fax

Practice location:
  • Phone: 612-205-7792
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number13744
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: