Healthcare Provider Details

I. General information

NPI: 1851036420
Provider Name (Legal Business Name): BARNI ILHAN OMAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 81ST AVE NE
SPRING LAKE PARK MN
55432-2116
US

IV. Provider business mailing address

1330 81ST AVE NE
SPRING LAKE PARK MN
55432-2116
US

V. Phone/Fax

Practice location:
  • Phone: 612-472-1234
  • Fax:
Mailing address:
  • Phone: 612-208-2587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA0833
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: