Healthcare Provider Details

I. General information

NPI: 1467380956
Provider Name (Legal Business Name): NASRI A OMAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 ENERGY PARK DR STE 17
SAINT PAUL MN
55108-5248
US

IV. Provider business mailing address

210 19TH AVE NE
MINNEAPOLIS MN
55418-4312
US

V. Phone/Fax

Practice location:
  • Phone: 612-212-9918
  • Fax: 912-513-2053
Mailing address:
  • Phone: 612-212-9918
  • Fax: 952-513-2053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: