Healthcare Provider Details

I. General information

NPI: 1902368178
Provider Name (Legal Business Name): ASHA FARAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 04/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3321 32ND ST S APT 107
FARGO ND
58104-8861
US

IV. Provider business mailing address

3321 32ND ST S APT 107
FARGO ND
58104-8861
US

V. Phone/Fax

Practice location:
  • Phone: 701-541-6140
  • Fax:
Mailing address:
  • Phone: 701-541-6140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number2459684
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: