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General NPI Number Information
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NPI Number | 1689488389
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Entity Type | Organization
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Legal Business Name | JMI RECUPERATIVE CARE LLC
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Dates
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Enumeration Date | 02/03/2025
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 12310 SINGLETREE LN APT 2344
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-7983
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Country | US
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Telephone | 585-967-1794
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Fax |
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Provider Business Mailing Address
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Address Line | 12310 SINGLETREE LN APT 2344
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-7983
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Country | US
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Telephone | 585-967-1794
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | FARDOWSA FARAH OSMAN
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Credential | NP
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Telephone | 612-245-8475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State |
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