Healthcare Provider Details

I. General information

NPI: 1801059431
Provider Name (Legal Business Name): IDIL SAID NUR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 UNIVERSITY AVE W SUITE S-305
SAINT PAUL MN
55104-2801
US

IV. Provider business mailing address

1821 UNIVERSITY AVE W SUITE S-305
SAINT PAUL MN
55104-2801
US

V. Phone/Fax

Practice location:
  • Phone: 612-226-9485
  • Fax: 651-222-3585
Mailing address:
  • Phone: 612-226-9485
  • Fax: 651-222-3585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number25979
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberR1757365
License Number StateMN

VIII. Authorized Official

Name: IDIL SAID NUR
Title or Position: PRESIDENT & OWNER
Credential: RN
Phone: 612-226-9485