Provider Demographics
NPI:1326850322
Name:AGIRI, FAIZA GBEMISOLA
Entity type:Individual
Prefix:
First Name:FAIZA
Middle Name:GBEMISOLA
Last Name:AGIRI
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 1:3540 18TH ST S APT 103
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-7118
Mailing Address - Country:US
Mailing Address - Phone:872-305-7704
Mailing Address - Fax:
Practice Address - Street 1:3540 18TH ST S APT 103
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-7118
Practice Address - Country:US
Practice Address - Phone:872-305-7704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-25
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home