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General NPI Number Information
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NPI Number | 1043168586
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Entity Type | Individual
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Provider Name | IBRAHIM NOUR
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Gender | Male
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Dates
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Enumeration Date | 03/19/2026
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Last Update Date | 03/19/2026
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Provider Practice Location Address
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Address Line | 1350 ENERGY LN STE 110A
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City | SAINT PAUL
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State | MN
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Zip | 55108-5254
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Country | US
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Telephone | 612-323-1438
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Fax |
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Provider Business Mailing Address
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Address Line | 1350 ENERGY LN STE 110A
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City | SAINT PAUL
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State | MN
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Zip | 55108-5254
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Country | US
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Telephone | 612-323-1438
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 1126343
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License Number State | MN
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