Healthcare Provider Details

I. General information

NPI: 1821616764
Provider Name (Legal Business Name): NOUSSAIBA AYOUR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2020
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5939 PORTLAND AVE
MINNEAPOLIS MN
55417-3127
US

IV. Provider business mailing address

14369 FAIRWAY DR
EDEN PRAIRIE MN
55344-1956
US

V. Phone/Fax

Practice location:
  • Phone: 612-869-4444
  • Fax: 612-254-8244
Mailing address:
  • Phone: 952-607-0217
  • Fax: 800-398-8041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number8197-23
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number14582
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberTPPA755
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: