Provider Demographics
NPI:1104636612
Name:TIFOW, NASRAH JAMAL
Entity type:Individual
Prefix:
First Name:NASRAH
Middle Name:JAMAL
Last Name:TIFOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7533 SHERIDAN AVE S
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-3559
Mailing Address - Country:US
Mailing Address - Phone:612-501-6472
Mailing Address - Fax:
Practice Address - Street 1:7533 SHERIDAN AVE S
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-3559
Practice Address - Country:US
Practice Address - Phone:612-501-6472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Single Specialty