Provider Demographics
NPI:1366755464
Name:BOUKARI, FAISALE SALE (RN)
Entity type:Individual
Prefix:MR
First Name:FAISALE
Middle Name:SALE
Last Name:BOUKARI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12017 PENNSYLVANIA AVE N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-2233
Mailing Address - Country:US
Mailing Address - Phone:612-281-5754
Mailing Address - Fax:
Practice Address - Street 1:12017 PENNSYLVANIA AVE N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-2233
Practice Address - Country:US
Practice Address - Phone:612-281-5754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-17
Last Update Date:2010-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 185771-5163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse