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General NPI Number Information
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NPI Number | 1891243358
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Entity Type | Individual
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Provider Name | MOHAMED FARAH FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 09/13/2016
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 1527 E LAKE ST STE 1
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City | MINNEAPOLIS
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State | MN
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Zip | 55407-6700
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Country | US
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Telephone | 612-345-7175
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Fax | 612-778-9857
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Provider Business Mailing Address
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Address Line | 1527 E LAKE ST STE 1
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City | MINNEAPOLIS
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State | MN
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Zip | 55407-6700
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Country | US
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Telephone | 612-345-7175
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Fax | 612-778-9857
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN52206
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP161085
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 12473
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License Number State | MN
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