Healthcare Provider Details

I. General information

NPI: 1649035213
Provider Name (Legal Business Name): HEALINGMED CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 UNIVERSITY AVE W STE 107-12
SAINT PAUL MN
55104-0049
US

IV. Provider business mailing address

14369 FAIRWAY DR
EDEN PRAIRIE MN
55344-1956
US

V. Phone/Fax

Practice location:
  • Phone: 952-607-0217
  • Fax:
Mailing address:
  • Phone: 952-607-0217
  • Fax: 800-398-8041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NOUSSAIBA AYOUR
Title or Position: FOUNDER
Credential: PA-C
Phone: 952-607-0217