Healthcare Provider Details

I. General information

NPI: 1780007336
Provider Name (Legal Business Name): OMAR SINGHATEH RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2014
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E SUPERIOR ST STE 201
DULUTH MN
55802-2228
US

IV. Provider business mailing address

3129 HONEYWOOD LN APT B
ROANOKE VA
24018-8843
US

V. Phone/Fax

Practice location:
  • Phone: 218-249-3057
  • Fax:
Mailing address:
  • Phone: 646-327-7306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number13449
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: