Healthcare Provider Details

I. General information

NPI: 1275943631
Provider Name (Legal Business Name): NASIM PARSA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CENTRACARE CIR STE 2400
ST CLOUD MN
56303-5000
US

IV. Provider business mailing address

1900 CENTRACARE CIR STE 2400
ST CLOUD MN
56303-5000
US

V. Phone/Fax

Practice location:
  • Phone: 320-229-4916
  • Fax: 320-229-5174
Mailing address:
  • Phone: 320-229-4916
  • Fax: 320-229-5174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number71812
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: