Provider Demographics
NPI:1215154133
Name:MERCHANT, NILOUFER MOIZ (EDD)
Entity type:Individual
Prefix:DR
First Name:NILOUFER
Middle Name:MOIZ
Last Name:MERCHANT
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 MONROE PL
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1652
Mailing Address - Country:US
Mailing Address - Phone:320-253-3753
Mailing Address - Fax:
Practice Address - Street 1:22 WILSON AVE NE
Practice Address - Street 2:SUITE 110
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56304-0440
Practice Address - Country:US
Practice Address - Phone:320-251-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3296103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN273694000Medicaid