Healthcare Provider Details

I. General information

NPI: 1487423653
Provider Name (Legal Business Name): MUNA NUR FARAH PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2469 UNIVERSITY AVE W STE 100E
SAINT PAUL MN
55114-8717
US

IV. Provider business mailing address

2469 UNIVERSITY AVE W STE 100E
SAINT PAUL MN
55114-8717
US

V. Phone/Fax

Practice location:
  • Phone: 651-316-4555
  • Fax: 651-797-6341
Mailing address:
  • Phone: 651-316-4555
  • Fax: 651-797-6341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11127
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: